title: Results of aberrant right subclavian artery aneurysm repair.
abstract: OBJECTIVE
  The objective of this multicenter registry was to review current treatments and late results of repair of aneurysm of aberrant right subclavian artery (AARSA).
  
  
  METHODS
  All consecutive AARSA repairs from 2006 to 2013 in seven centers were reviewed. End points were 30-day and late mortality, reintervention rate, and AARSA-related death.
  
  
  RESULTS
  Twenty-one AARSA repairs were included (57% men; mean age, 67 years); 3 ruptures (14%) required emergent treatment; 12 (57%) were symptomatic for dysphagia (33%), dysphonia (24%), or pain (19%). Eight cases (38%) presented with thoracic aortic aneurysm, two with intramural hematoma, and one with acute type B aortic dissection. Mean AARSA diameter was 4.2 cm; a single bicarotid common trunk was present in 38% of cases. The majority of patients underwent hybrid intervention (n = 15; 71%) consisting of single (n = 2) or bilateral (n = 12) subclavian to carotid transposition or bypass or ascending aorta to subclavian bypass (n = 1) plus thoracic endovascular aortic repair (TEVAR); 19% of cases underwent open repair and 9% simple TEVAR with AARSA overstenting. Perioperative death occurred in two patients (9%): in one case after TEVAR in ruptured AARSA, requiring secondary sternotomy and aortic banding; and in an elective case due to multiorgan failure after a hybrid procedure. Median follow-up was 30 (interquartile range, 15-46) months. The Kaplan-Meier estimate of survival at 36 months was 90% (standard error, 0.64). Late AARSA-related death in one case was due to AARSA-esophageal fistula presenting with continuing backflow from distal AARSA and previous TEVAR. At computed tomography controls, one type I endoleak and one type II endoleak were detected; the latter required reintervention by aneurysm wrapping and ligature of collaterals. AARSA-related death was more frequent after TEVAR, a procedure reserved for ruptures, compared with elective open or hybrid repair.
  
  
  CONCLUSIONS
  Hybrid repair is the preferred therapeutic option for patients presenting with AARSA. Midterm results show high rates of clinical success with low risk of reintervention. Simple endografting presents high risk of related death; these findings underline the importance of achieving complete sealing to avoid treatment failures.
authors.affiliation: Unit of Vascular Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy. Electronic address: fabio.verzini@unipg.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Verzini
authors.affiliation: Unit of Vascular Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Isernia
authors.affiliation: Unit of Vascular Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
authors.forename: Gioele
authors.initials: G
authors.lastname: Simonte
authors.affiliation: Unit of Vascular Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: De Rango
authors.affiliation: Unit of Vascular Surgery, Department of Cardiosciences, Hospital S. Camillo Forlanini, Rome, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Cao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D018376:Cardiovascular Abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed