Stent Graft Repair of a Ruptured Aberrant Right Subclavian Artery after Open Repair

An aberrant right subclavian artery (ARSA) arising from the proximal portion of the descending thoracic aorta is the most common congenital anomaly of the aortic arch. This irregularity occurs in 0.51% of the population. Degenerative aneurysmal changes may occur in the proximal portion of an ARSA or at its aortic origin. This abnormal vessel passes posterior to the esophagus, and, in rare cases, may cause dysphagia or massive hemoptysis if associated with vasculitis or an aneurysmal diverticulum of Kommerell. Open repair is typically performed for such patients; however, this procedure may be associated with a high rate of neurological complications and a mortality of up to 30%, particularly in patients contraindicated for major open vascular reconstruction. In addition, open repair may be contraindicated in patients with a history of thoracotomy. Because thoracotomy and aortic clamping are the most crucial steps of open repair, a combination of aortic endografting and extra-anatomic bypass is particularly appealing for the management of this condition. We report the successful repair of a ruptured ARSA after open repair in an 81-year-old patient without vascular ring symptoms.