Management of aberrant subclavian artery aneurysms

An aberrant subclavian artery is the most common congenital anomaly of the aortic arch. Aneurysms of these vessels are relatively rare lesions. A high clinical suspicion must be maintained in patients with an abnormal mediastinum on chest X-ray, especially in patients with dysphagia, dyspnea, or upper extremity ischemic symptoms not otherwise explained. Potentially disastrous complications, including spontaneous rupture and perforation into the esophagus may occur, and are invariably fatal. We present the case of an 1 asymptomatic 72-year-old male with an aberrant right c subclavian artery aneurysm presenting as a mediastinal mass on routine chest X-ray. Repair was by aneurysmectomy through a left thoracotomy and right common carotid artery to subclavian artery bypass via median sternotomy with resolution of his symptoms. We reviewed 74 cases in the English literature to February 1998. The pertinent anatomy is discussed and trends in surgical treatment are identified. Recent agreement on the surgical approach and choice of revascularization appears to exist, but advances in diagnostic and interventional radiologic capabilities have increased the number of asymptomatic lesions encountered and may alter the treatment of this lesion in the near future.