Aberrant Subclavian Artery: Presentation and Outcomes

Abstract

Objectives: Aberrant subclavian artery (ASA) is one of most frequent aortic arch anomalies. Many authors recommend treatment of symptomatic or aneurysmal aberrant subclavian arteries, but most of these recommendations are based on small case series or anecdotal experience. Natural history of this anomaly is not well defined. Our aim was to review long term outcomes in patients with this anomaly. Methods: A retrospective review of all adult patients seen at Mayo Clinic between 1997 and 2011 with a diagnosis of ASA was performed after approval from our institutional review board. Demographic factors and outcome data was collected and analyzed. All patients were diagnosed based on imaging studies. Results: There were 446 patients with diagnosis of Asa and mean age at diagnosis was 54.7 years (range 1month- 93 years). There were 102 aberrant left and 344 aberrant right subclavian arteries in 164 male and 284 female patients. There were more female patients than male with right ASA (2:1) versus similar distribution for left ASA (1.25:1). Forty five (10%) patients were symptomatic, the most common symptoms being dysphagia and/or respiratory. These were presumed from compression, although most patients noted to have esophageal compression on radiographic study had no dysphagia. Forty two patients (9.4%) underwent surgical intervention for ASA, all were symptomatic or had aneurysmal degeneration. No patient presented urgently, except one with acute upper extremity ischemia in conjunction with aortic and subclavian dissection and underlying right Asa. Mean follow up duration was 6.3 years (range 0-70 years). None of the patients followed conservatively developed any complications related to the ASA. Conclusions: Aberrant subclavian artery is a benign anomaly and has no significant long term consequences. Intervention is recommended in symptomatic patients, in whom other causes for symptoms have been ruled out. Multiple surgical options should be tailored patient specific problems.