An aberrant origin of the right subclavian artery arising as the most distal vessel from the aortic arch is an uncommon but clinically important anomaly. Its abnormal course may result in esophageal compression with dysphagia, or tracheal compression resulting in asthma or stridor, and can greatly complicate radial artery access for coronary angiography. When an aberrant right subclavian artery is obstructed by atherosclerotic plaque, it may produce symptoms of arm ischemia such as pain and weakness. For the past 75 years, the standard treatment approach for symptomatic aberrant right subclavian artery has been surgical correction. There are only three case reports of percutaneous therapy, all for nonocclusive stenosis. There are no reported cases of percutaneous treatment of a completely occluded aberrant right subclavian artery. We report a patient with exertional right arm heaviness and weakness who was found to have a 60-mm long aberrant right subclavian artery occlusion. The blockage was successfully treated with angioplasty and placement of a single stent using percutaneous vascular access. Chest computerized tomography and duplex ultrasonography 5 years after treatment demonstrated a patent stent. At 7-year follow-up, she remained symptom-free and had a normal radial pulse. This case represents the first report of total occlusion of aberrant right subclavian artery treated percutaneously. Long-term durability supports this as a viable alternative to surgery in appropriately selected patients.
An interesting case of aberrant right subclavian artery occlusion with subclavian steal phenomenon salvaged by endovascular therapy
