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• Blunt thoracic aortic injuries are life threatening and require urgent intervention. • Rare presentation of a blunt thoracic aortic injury in a patient with an aberrant right subclavian artery off the aortic arch distal to the takeoff of the left subclavian artery. • An aberrant right subclavian artery originating from the aortic arch, distal to the left subclavian artery is an anatomic variant that adds significant complexity to TEVAR. Blunt thoracic aortic injuries (BTAIs) are an uncommon traumatic injury that if not treated promptly, can result in death. We present the case of a BTAI with aberrant aortic anatomy. A 60-year-old female was involved in a motor vehicle crash where she suffered significant polytrauma including a BTAI. She was also found to have an aberrant right subclavian artery originating from the aortic arch. Thoracic Endovascular Aortic Repair (TEVAR) with a right common carotid artery to right subclavian artery bypass was accomplished. She required three more vascular surgical interventions, two for persistent type II endoleak and the third for left upper extremity acute limb ischemia. She had a 2-month hospital course for her devastating injuries and was eventually discharged home. A follow-up CT angiogram showed a stable thoracic aortic arch stent. BTAIs are uncommon in the trauma population. In our patient who had an aberrant right subclavian artery, further procedures were required in the form of a right common carotid artery to right subclavian artery bypass and embolizations to resolve endoleaks. Blunt thoracic aortic injuries are life threatening and require urgent intervention. TEVAR is associated with better outcomes. An aberrant right subclavian artery originating from the aortic arch, distal to the left subclavian artery is an anatomic variant that adds significant complexity to TEVAR. TEVAR is still an option for repair of blunt thoracic aortic injuries despite anatomic variations as open repair still carries an increased risk of morbidity and mortality. [ABSTRACT FROM AUTHOR]

• Aberrant Right Subclavian artery is also known as Arteria Lusoria. • Rarer congenital malformations of the aortic arch. • Causes compression of the trachea or esophagus causing dysphagia. • May occur simultaneously with an ostium secundum atrial septal defect. • Both conditions repaired simultaneously via Median Sternotomy. Aberrant right subclavian artery, also known as arteria lusoria, is one of the rarer congenital vascular malformations of the left sided aortic arch which arises distal to the left subclavian artery, following a retroesophageal course to the right side causing compression of the trachea or esophagus and resulting in a variety of symptoms most commonly dysphagia. We report a case of a two and a half year old child who was diagnosed as having as having an aberrant right subclavian artery with an ostium secundum atrial septal defect and underwent simultaneous repair of both conditions via a median sternotomy. Aberrant right subclavian artery (ARSA) has a prevalence of 1.8 % and most commonly presents in fourth or fifth decade of life. Various surgical approaches have been described to repair this anomaly over the past years, each with its own limitations and complications. However, the median sternotomy approach provides adequate exposure during division and re-implantation of the vessel and simultaneously allows repair of any intra-cardiac defect. We believe that the best exposure for the correction of aberrant right subclavian artery is via a median sternotomy, especially in pediatric patients associated with other cardiac anomalies. [ABSTRACT FROM AUTHOR]

• Aberrant right subclavian artery (ARSA), or arteria lusoria is the most common embrologic anomaly of the aortic arch. • The ARSA arises after the origin of the left subclavian artery and then reaches the posterior mediastinum. • The presence of ARSA is generally asymptomatic, but may cause complications, during some endovascular procedures. • Prompt diagnosis and treatment is required to avoid more dreadful complications. Aberrant right subclavian artery (ARSA), or arteria lusoria is the most common embrologic anomaly of the aortic arch. It is generally asymptomatic and incidentally diagnosed during a radiological exam or procedure. Here, we report a case of ARSA incidentally diagnosed and injured (dissection with mediastinal hematoma) during a right transradial coronary angiography in a 83 years old female patient. The patient underwent prompt hybrid procedure with the isolation of the right humeral artery from where we positioned a GORE® VIABAHN® 9 × 100 mm endoprosthesis. The procedure was successful with optimal results at early and long term follow up. Sometimes, a dissection of the ARSA may occur, especially for excessive manipulation during endovascular procedures, and when such complication happens it should be promptly treated as it can be life-threatening. If transradial catheterization during coronary angiography becomes particularly difficult, requires longer time, or the guide wire enters in the descending aorta, particularly attention should be paid, as dreadful complications such as dissection or lesion may happen and prompt treatment is required. [ABSTRACT FROM AUTHOR]

Introduction Aneurysmal degeneration of aberrant right subclavian artery (ARSA) carries a relevant risk of rupture. Timely elective treatment is mandatory. Therapeutic options include open surgery repair or hybrid surgical and endovascular repair. Few reports of total endovascular approach repair have been reported. Presentation of the case We report the first case of total endovascular repair of an aneurysmal ARSA using a thoracic aortic endograft with a “periscope” covered stent into the ARSA itself. Discussion The total endovascular approach was considered for patient’s age and her poor compliance to the idea of a surgical revascularization of the ARSA, which has to be preserved since the LSA was diseased. The urgent situation did not allow for the use of a custom-made graft, so the idea of a “periscope” covered graft both to preserve the flow of the ARSA and to exclude the aneurysmal lesion seemed to be the best choice. Conclusion The “periscope” technique allowed the urgent treatment of aneurysmal ARSA with good clinical results. [ABSTRACT FROM AUTHOR]

Aberrant right subclavian artery (ARSA) and Kommerell's diverticulum (KD) are common vascular anomalies of the aortic arch. Anatomic reconstruction of ARSA is difficult with only the median sternotomy approach. A 55-year-old woman was referred to our hospital for a thoracic aneurysm. CT showed 46 mm diameter of distal aortic arch aneurysm with ARSA and KD. ARSA branched from the distal aortic arch and crossed behind the esophagus. It was difficult to reconstruct ARSA anatomically via the median sternotomy approach. We performed coil embolization of ARSA and total aortic arch replacement (TAR) and extra-anatomic right subclavian artery reconstruction for the distal aortic arch aneurysm with ARSA and KD. The patient was discharged home with no complications. There were differences in blood pressure of the upper extremities after coil embolization of ARSA; however, subclavian steal syndrome or cerebral complications did not occur. If there is no abnormal finding in head and neck arteries before surgery, coil embolization of ARSA is safe and open distal anastomosis of the distal aortic arch can be performed in a bloodless field. Hybrid repair by coil embolization and TAR for the distal aortic arch aneurysm with ARSA and KD were considered to be a useful in the absence of cerebral vascular stenosis or obstruction. • Anatomic reconstruction of aortic arch anomaly with aortic aneurysm is difficult. • Hybrid repair by coil embolization and open surgery is useful and safe. [ABSTRACT FROM AUTHOR]

Kommerell diverticulum is a very rare congenital defect of the aortic arch associated with the aberrant subclavian artery. It can present with signs of dysphagia, chest pain, or distal embolization in the upper limb. We present a case of Kommerell diverticulum with associated large subclavian artery aneurysm in a male patient with chest pain of unknown origin and hypertension. There was an incidental finding of the wide mediastinum on chest X-ray and the patient had a difference in systolic blood pressure in both arms. A right thoracotomy incision was used to successfully excise the aneurysm and reconstruct the subclavian artery. Patient recovery was uneventful. Endovascular approaches are also an alternative to conventional open surgeries in the treatment of Kommerell diverticulum. Kommerell diverticulum with subclavian artery aneurysm should be considered in the differential diagnosis of non-cardiac chest pain. A simple investigation such as a chest X-ray can make a difference in these patients. Coarctation related to the right ASA might not always be a true coarctation. Endovascular treatment is an alternative to open repair in selected cases, but it needs further investigation in large randomized control trials. • Kommerell's diverticulum (KD) is an extremely rare developmental abnormality with prevalence of right aberrant subclavian artery originating from the left aortic arch has been reported to be 0.7%–2.0%. • The catastrophic events of aneurysm rupture and aortic dissection has been reported to be 53% and 19% respectively. • aggressive surgical treatment is suggested for KD larger than 3cm at the origin and symptomatic aneurysms larger than 5 cm. • All symptomatic patients with compressive symptoms should undergo open repair rather than endovascular repair. • Coarctation of aorta is associated in 1 % of cases of right aberrant subclavian artery while only 150 cases of pseudocoarctation has been reported in literature. [ABSTRACT FROM AUTHOR]

Abstract: INTRODUCTION: An aberrant right subclavian artery (ARSA) or lusorian artery is one of the most common variations of the aortic arch. Although usually without symptoms, some ARSA's occasionally become symptomatic. PRESENTATION OF CASE: A 51-year old woman presented with a painful right middle finger. Clinical examination showed thenar muscle hypotrophy and blue discoloration of the distal phalanx suggestive of embolization. Magnetic resonance angiography revealed a non-aneurysmal proximally occluded ARSA. A venous common carotid artery to subclavian artery bypass was combined with ARSA ligation proximal to the right vertebral artery. DISCUSSION: Occlusive symptomatic ARSA disease without aneurysmal dilatation is uncommon. Treatment may include bypass grafting by open surgery or angioplasty with stenting. CONCLUSION: Treatment for occlusive non-aneurysmal ARSA must be tailored to the individual. Whether an endovascular or surgical approach is preferred depends on localization of the lesion in relation to the esophagus and on the general condition of the patient. [Copyright &y& Elsevier]