A new surgical approach to the management of symptomatic aberrant right subclavian artery.

Aberrant right subclavian artery is a rare congenital anomaly that usually does not produce symptoms. Symptomatic patients require surgical intervention. Ligation of the aberrant artery through a left thoracotomy has been advocated as the operation of choice. If development of vertebrobasilar insufficiency is anticipated, division and ligation of the aberrant artery and its anastomosis to the right common carotid artery or aortic arch are performed at a second operation. In the procedure advocated here, both ligation and anastomosis of the aberrant artery are performed simultaneously through midsternotomy. Normal blood flow is thereby established to the right upper extremity, which obviates any early or late complications.