Hybrid treatment of aberrant right subclavian artery and its aneurysms.

PURPOSE: To describe two cases of aberrant right subclavian artery (ARSA) aneurysm treated with hybrid repair. CASE REPORTS: 77 year old woman with a symptomatic ARSA aneurysm was treated with endoluminal aortic stent graft exclusion and placement of a plug distal to the aneurysm. Ischemia of the right arm required immediate carotid-subclavian bypass. Postoperatively, mild signs of brain stem infarction were present with absent flow in the right vertebral artery. Because of preserved left vertebral and basilary artery flow no invasive therapy was undertaken. The patient recovered completely. A 51 year old woman with a symptomatic 37 mm diameter ARSA aneurysm underwent bilateral carotid-subclavian bypasses and subsequent endoluminal aortic stent graft exclusion of the ARSA's origin. Recovery was uneventful.
CONCLUSION: Hybrid techniques are less invasive valuable alternatives in the treatment of ARSA and its aneurysms. Great care should be taken to preserve the posterior cerebral and upper extremity circulation.