Outcomes of Complex Surgery for Lusoria Artery in Adults: A Multicenter Study

E. Deniz; F. Helms; B. Schmack; H. Krüger; I. Rogalski; T. J. Demal; C. Detter; H. Reichenspurner; J. Van Puyvelde; P. Verbrugghe; B. Meyns; O. Dzemali; L. Ilcheva; A. Ruhparwar; P. Risteski; A. F. Popov

doi:10.1055/s-0045-1804114

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2025; 73(S 01): S1-S71
DOI: 10.1055/s-0045-1804114

Sunday, 16 February

RUND UM DIE AORTA

Outcomes of Complex Surgery for Lusoria Artery in Adults: A Multicenter Study

E. Deniz

¹Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland

,

F. Helms

¹Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland

,

B. Schmack

¹Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland

,

H. Krüger

¹Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland

,

I. Rogalski

¹Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland

,

T. J. Demal

²Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Deutschland

,

C. Detter

²Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Deutschland

,

H. Reichenspurner

²Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Deutschland

,

J. Van Puyvelde

³Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium

,

P. Verbrugghe

³Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium

,

B. Meyns

³Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium

,

O. Dzemali

⁴Department of Cardiac Surgery University Hospital Zurich, Zürich, Switzerland

,

L. Ilcheva

⁴Department of Cardiac Surgery University Hospital Zurich, Zürich, Switzerland

,

A. Ruhparwar

¹Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland

,

P. Risteski

⁴Department of Cardiac Surgery University Hospital Zurich, Zürich, Switzerland

,

A. F. Popov

¹Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland

› Author Affiliations

Abstract

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Background: Although an aberrant subclavian artery (aSA) is the most common congenital anomaly of the aortic arch, with a prevalence of only 0.5 to 2.2%, it is a very rare and surgically challenging disease. Patients can suffer from dysphagia and dyspnea, depending on the anatomical pathway and the severity, but usually it is discovered incidentally. Therefore, surgical treatment and outcome are not well investigated. Large-scale multi-center clinical trials do not exist, and there is paucity of reported studies in small single-center series. The aim of this study is to analyze, in a huge collective, the indications, surgical strategies, and outcomes after surgical treatment of an aSA with a multi-center study.

Methods: All patients who received invasive treatment for aSA between 1993 and 2024 were included in this retrospective international multicenter observational study (Germany, Switzerland, and Belgium). Patient-related data obtained from patients’ medical records were collected retrospectively in a local clinical database. Indications, surgical techniques, symptom improvement, and survival of patients undergoing surgery for aSA pathology were assessed.

Results: A total of 56 patients with aSA were identified, 30 (53.6%) of whom were male. The average age for the cohort was 50.8 ± 18.7 years. In 48 cases, the diagnosis was made via CT, 6 cases via MRI, and in 2 patients, no previous diagnostic was available. The most seen anomaly was right aSA at 73%. 45 of 56 (80%) were symptomatic. Planned aortic replacement was performed in 49 of 56 patients (87.5%). The other 7 surgical treatments were emergency cases. In 66% of cases, the repair was performed as a one-stage procedure. The surgical approach ranged from hemisternotomy (n = 3), full sternotomy (n = 28), and lateral thoracotomy (n = 19). In 11 patients, the aSA was treated interventionally. No intraoperative or interventional mortality was seen, and the in-hospital as well as the 30-day mortality rates were 5%. 48 patients could be followed up for more than 1 year, with an overall survival rate of 88%. Symptoms resolved in 25 of 45 cases.

Conclusion: Despite the rarity of an aSA and the different techniques according to the anatomy, outstanding results can be achieved based on the expertise of the surgery centers. Our study indicates that the surgical techniques used to treat ASA relieve symptoms with low rates of mortality.