Feasibility, outcomes and technique of symptomatic aberrant right subclavian artery reimplantation via a right collar incision in children: A case series

Introduction: Symptomatic incomplete vascular rings resulting from aberrant right subclavian arteries (ARSA) are usually repaired with a subclavian to carotid transposition via a right thoracotomy or median sternotomy approach. We describe the successful use and long-term outcomes of a less invasive approach via a right collar incision for ARSA repair in a pediatric case series. Case presentations: Between January 2020 and December 2022, four pediatric patients with symptomatic ARSAs underwent operative repair using a right collar incision on the pediatric general and thoracic surgery service at a quaternary pediatric medical center. Demographic information, clinical characteristics and intra-operative complications were obtained from retrospective review of the medical record. Structured telephone interviews using a survey tool adapted from the Self Evaluation of Breathing Questionnaire and the PEDI-EAT 10 collected data on long-term symptomatic improvement.Two patients were male, and two were female. Age at time of operation ranged from 9 to 38 months. In all patients, the operative indication was dysphagia in the setting of an ARSA with no additional symptom etiology of symptoms identified. No patients required postoperative intensive care unit admission. Hospital length of stay was 2 days for all patients. There were no intra-operative complications. All patients experienced long-term symptomatic improvement following their operation with 100 % reporting symptomatic improvement and none reporting symptom recurrence. Conclusion: A right collar incision is a feasible and effective approach for subclavian to carotid transposition of ARSA in pediatric patients and should be considered for operative intervention of symptomatic aberrant right subclavian arteries.