Successfully combined management of the abberant retroesophageal arteria subcalvia dextra aneurysm (arteria lusoria)

INTRODUCTION: Aberrant right subclavian artery arising from the distal part of the aortic arch and passing behind the oesophagus (arteria lusoria) is a rare congenital vascular anomaly, it is the 4th most common aortic arch anomaly. At the site of the orifice there is the Kommerell's diverticulum, which is the locus minoris resistentiae with the possible arise of the aortic aneurysm. Aneurysmatic dilatation of the anomalous artery and of the aorta may be the cause of distal embolism or rupture. Less frequently there is also the possibility of aortic dissection or traumatic rupture. CASE REPORT: 54-old man with a symptomatic aberrant aneurysmatic dilated right subclavian artery (arteria lusoria) and an anerurysmatic dilatation of the Kommerell's diverticulum was indicated to staged combined management. Firstly we performed open surgical debranching of two supraaortic trunks (both subclavian arteries). Thereafter we excluded the orifice of the aberrant artery with the Kommerell's diverticulum by use of the endovascular techniques. There have been no complications during the perioperative period and the effect of surgery was optimal. DISCUSSION: It is generally accepted that the presence of aneurysm of the aberrant right subclavian artery is an indication for surgery, whether symptomatic or not. The conventional surgery is usually staged. Firstly there is a carotid-subclavian bypass or transposition on the right side and thereafter a transthoracic resection of the Kommerell's diverticulum and aortic angioplasty. The combined management with supraaortic revascularization followed with the stentgraft exclusion of the aneurysm is a sophisticated alternative. CONCLUSION: Experiences with the combined treatment published in the literature and ours are excellent, this technique is miniinvasive with a low complication rate. In our opinion it is the management of choice.