A 63-year-old female presented having suffered an embolic event to her right index finger. This resolved successfully with conservative treatment via development of collateral channels. The finger is fully viable, albeit mildly insensitive. She has had some dysphagia, with one specific choking episode when a lozenge became lodged in the esophagus, causing discomfort and cough until it dissolved spontaneously.
Work-up revealed an aberrant right subclavian artery, with associated Kommerell's dilatation and a 1 cm wide ulcerated area near its origin from the aorta, as well as an arteriosclerotic irregularity of the proximal subclavian artery. Passage of the aberrant subclavian artery behind the trachea and esophagus produced esophageal compression. See computed tomography (CT) scan images in Figure 1.
The question regarding this case was:
How would you correct this lesion?
Intraluminal endovascular treatment
Combined surgical-endovascular approach (hybrid operation) with right subclavian artery transposition and thoracic aortic stent graft implantation
The respondents who selected the open surgery option were asked:
Please indicate—open surgery to include which of the following (multiple choice question):
Left thoracotomy for division of subclavian artery and, thus, interruption of vascular ring
Neck approach for ligation of subclavian artery (to allow thrombosis of aberrant artery), with carotid to subclavian bypass for distal perfusion
Ligation of thyrocervical trunk and internal mammary artery (IMA)
Selection of the “Other approach” option to the main question and the “Other” option to the secondary question prompted a text field where the respondents could describe their approach.
The poll was distributed among all current members of the Editorial Board, who were asked to submit their responses via an online survey tool. The list of Editorial Board members can be found the AORTA journal website (http://aorta.scienceinternational.org). The members of the Editorial Board whose practice does not lie within the scope of this question were asked to disregard this poll. Here we present the results of this poll.
Results of the “Poll the Editorial Board”
|Preferred technique for open surgical treatment of an aberrant right subclavian artery||No. of votes||Percentage|
|Left thoracotomy for division of subclavian artery and, thus, interruption of vascular ring||7||70%|
|Neck approach for ligation of subclavian artery (to allow thrombosis of aberrant artery), with carotid to subclavian bypass for distal perfusion||4||40%|
|Ligation of thyrocervical trunk and IMA||0||0|
* The two respondents that selected the response “Other” indicated the following as their preferred technique for open surgery:
The results of the poll show the increasing popularity of the hybrid procedures with the majority of the respondents (55%) indicating their preference for the combined surgical and endovascular approach, 30% of the respondents selecting open surgery as their preferred technique, while 12% favored an intraluminal endovascular treatment approach. Interestingly, among the respondents that showed preference for open surgery, seven (70%) indicated the left thoracotomy approach to be their preference. At the same time three (30%) respondents stated that the combined left thoracotomy and neck approach is their preference. Only one respondent (10%) selected the isolated neck approach for ligation of the subclavian artery with a carotid to subclavian bypass for distal perfusion, while no respondents showed preference toward ligation of the thyrocervical trunk and IMA. Two respondents provided other alternative strategies for open surgical treatment (see Table 1).