Aortic arch and frozen elephant trunk repair of a right-sided aortic arch with pseudoaneurysm

A 53 year old male with a history of vascular ring repair secondary to a right sided aortic arch with retroesophageal subclavian artery and ligamentum arteriosum to the descending thoracic aorta presented to our institution with a large aortic pseudoaneurysm of the distal aortic arch. Computed tomography demonstrated a right sided aortic arch with a 5.8 cm pseudoaneurysm arising from the distal arch in the area of his previously divided ligamentum. The patient underwent a successful two-stage repair including a left carotid to subclavian bypass followed by total arch replacement with frozen elephant trunk. He recovered well postoperatively and computed tomography showed complete repair of the pseudoaneurysm with patent bypass graft.

Right retroesophageal subclavian artery

PURPOSE: The subclavian arteries can vary on their origin, course or length. One of the most common anatomical variations is the right subclavian artery originating as the last branch of the aortic arch. This artery is known as a retroesophageal right subclavian artery or "lusory artery". The right retroesophageal subclavian artery usually is described as not producing symptoms, being most discoveries coincidental. Nevertheless, it may be the site of formation of atherosclerotic plaque, inflammatory lesions or aneurysm. CASE REPORT: The present study describes a case of right retroesophageal subclavian artery and discusses the findings according to their clinical and surgical implications. CONCLUSION: The anatomic and morphologic variations of the aortic arch and its branches are significant for diagnostic and surgical procedures in the thorax and neck. If a right retroesophageal subclavian artery is diagnosed during aortic arch repair, corrective surgery should be considered. Intensive care patients should be screened before long term placement of nasogastic tube, in order to avoid fistulization and fatal hemorrhage.