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Aberrant subclavian artery

One-Stage Endovascular Treatment of a symptomatic Penetrating Ulcer in the Lusorian Artery and an AAA- a Challenging Case in a Rare Entity.
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One-Stage Endovascular Treatment of a symptomatic Penetrating Ulcer in the Lusorian Artery and an AAA- a Challenging Case in a Rare Entity.

Ann Vasc Surg. 2017 Jul 06;:

Authors: Esche M, Sebesta P, Seifert S

Abstract
INTRODUCTION: We report a case of a 57-year old man with a successful total endovascular treatment of a symptomatic penetrating arterial ulcer (PAU) of a lusorian artery together with a standard endovascular abdominal aortic aneurysm (AAA) repair. The lusorian artery is an aberrant subclavian artery and a congenital aortic arch anomaly with a reported prevalence of 0.4 to 2.6 %. Typical for the base of the lusorian artery is a Kommerell diverticulum making an endovascular approach even more difficult.
METHODS: The patient was admitted to our hospital due to an unspecific retrosternal and hypopharyngeal pulsation feeling. The contrast CT scan revealed a PAU in the middle of the aberrant right subclavian artery, apart from the size progression of an asymptomatic and followed-up AAA. Beside a standard abdominal EVAR, a total endovascular PAU exclusion was achieved by using an Endurant tapered leg extension. The system was released in a back-table procedure and then remounted reversed on the system which now could be introduced via a transverse arteriotomy of the right axillary artery.
RESULTS: The technical result was excellent, no endoleak was observed and the symptoms disappeared immediately. The patient was discharged symptom-free after 5 days.
SUMMARY: This is so far the first reported total endovascular therapy of a symptomatic PAU of a Lusorian artery. There are no tapered leg extensions or main bodies with a necessary working length for a femoral approach and correct sizing at the same time available on the market. The technical success was therefore based on the possibility of releasing and remounting parts of the Endurant Stentgraft System (Medtronic) in emergency cases in a back table setting. Although this is off-label use in experienced hands it easy to handle and can surely help the endovascular surgeon in some challenging situation where no standard stentgraft system is available.

PMID: 28689958 [PubMed - as supplied by publisher]

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