title: A Rare Entity: Traumatic Thoracic Aortic Injury in a Patient with Aberrant Right Subclavian Artery.
abstract: BACKGROUND
  Aberrant right subclavian artery is an uncommon entity incidence ranging from 0.5 to 2.5%. Management of thoracic aortic injury in the presence of such anomalies can be a challenge. We present here a case of traumatic aortic injury, which was incidentally found to have an asymptomatic aberrant right subclavian artery. The patient was managed by an endovascular repair of thoracic aortic injury with an endograft and a right carotid to subclavian artery bypass as a hybrid procedure.
  
  
  METHODS
  A 40-year male patient was brought to the emergency in shock with an alleged history of road traffic accident an hour back. After initial resuscitation as per advance trauma life support protocol, imaging revealed thoracic aortic injury with aberrant right subclavian artery with multiple rib and bilateral humerus fracture. After primary stabilization of arm fractures, the patient was shifted to a hybrid operation room. As the aortic injury was within 10 mm of the origin of both subclavian arteries, it was decided to cover the origin of both subclavian arteries and land the endograft distal to the left carotid artery origin. Since there was a right dominant vertebral artery on imaging, right carotid to right subclavian artery bypass was done with expanded polytetrafluoroethylene graft to prevent posterior circulatory stroke along with thoracic endovascular aortic repair to seal the thoracic aortic injury.
  
  
  RESULTS
  After endovascular repair of thoracic aortic injury, left subclavian artery perfusion was maintained through left vertebral artery; and hence, revascularization of left subclavian artery was deferred. After management of all fractures, the patient was discharged 3 weeks after the date of admission without any complications. At 6 months follow-up, patient was stable and images showed patent bypass graft and sealed aortic injury.
  
  
  CONCLUSIONS
  In a trauma setting with multiple injuries, hybrid procedure with a thoracic endograft is associated with low mortality and morbidity; hence, it is the treatment of choice for thoracic aortic injury over open surgical repair. A hybrid suite can be life and time saving in situations which mandate simultaneous endovascular repair along with surgical revascularization when indicated, especially in cases with aberrant aortic arch anatomy.
authors.affiliation: Division of Vascular and Endovascular Sciences, Medanta-The Medicity Hospital, Gurgaon, Haryana, India. Electronic address: patelhitenm@gmail.com.
authors.forename: Hiten Mohanbhai
authors.initials: HM
authors.lastname: Patel
authors.affiliation: Division of Vascular and Endovascular Sciences, Medanta-The Medicity Hospital, Gurgaon, Haryana, India.
authors.forename: Shubhabrata
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Division of Vascular and Endovascular Sciences, Medanta-The Medicity Hospital, Gurgaon, Haryana, India.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Bulsara
authors.affiliation: Division of Vascular and Endovascular Sciences, Medanta-The Medicity Hospital, Gurgaon, Haryana, India.
authors.forename: Tapish
authors.initials: T
authors.lastname: Sahu
authors.affiliation: Division of Vascular and Endovascular Sciences, Medanta-The Medicity Hospital, Gurgaon, Haryana, India.
authors.forename: Virender K
authors.initials: VK
authors.lastname: Sheorain
authors.affiliation: Division of Vascular and Endovascular Sciences, Medanta-The Medicity Hospital, Gurgaon, Haryana, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Grover
authors.affiliation: Division of Vascular and Endovascular Sciences, Medanta-The Medicity Hospital, Gurgaon, Haryana, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Parakh
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000783:Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D001027:Aortography / Q000379:methods; D058070:Asymptomatic Diseases; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D018376:Cardiovascular Abnormalities / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation; D006801:Humans; D033162:Incidental Findings; D008297:Male; D011474:Prosthesis Design; D012039:Regional Blood Flow; D013348:Subclavian Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery