PMC10278403_01
(a) Coronal view of computed contrasted angiography showing the atretic origin of the aberrant left subclavian artery (long arrow) with a distal bulbous segment and stenosis extending up to the origin of the left vertebral artery (short arrow). (b) Axial view showing the atretic segment of the aberrant left subclavian (arrow) and the Kommerell's diverticulum (star).
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Computed tomography angiogram (CTA) of the chest and neck showed a right-sided aortic arch with an aberrant left subclavian artery (Figure 1).
(a) 3D reconstructed CT angiography of the aortic arch showing the origins of the great vessels. Beginning proximally, the left common carotid artery (LCC), right common carotid artery (RCC), right subclavian (RSC), aberrant left subclavian artery (LSC). (b) There is severe stenosis (arrow) of the entire proximal aberrant left subclavian artery (LSC) beginning at its origin from the aortic arch and extending to the origin of the left vertebral artery (V). Distal to the Kommerell's diverticulum (star) is a completely atretic origin of the left subclavian artery.
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A 3D reconstruction showed the origin of the left subclavian was hypoplastic with a 2.4-cm segment of stenosis extending to the left vertebral artery (Figure 2).
3D reconstruction of the CT angiography of the head. The right vertebral artery (RV) is dominant compared to the left vertebral artery. There is no identifiable stenosis or lesion. Both anterior and inferior communicating arteries are normal. The posterior communicating arteries were not able to be identified.
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The 3D reconstruction showed a dominant right vertebral artery (Figure 3).
Carotid artery (long arrow), sternocleidomastoid muscle retracted laterally (star), 6 mm PTFE graft (triangle), and internal jugular vein (small arrow) retracted medially.
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Due to atretic left subclavian origin, long segment stenosis, and retro-esophageal course, we performed a left carotid-axillary bypass using an externally supported 6 mm polytetrafluoroethylene graft (Figures 4 and 5).
Axillary artery (long arrow), Axillary vein (short arrow), and PTFE graft (star).
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Due to atretic left subclavian origin, long segment stenosis, and retro-esophageal course, we performed a left carotid-axillary bypass using an externally supported 6 mm polytetrafluoroethylene graft (Figures 4 and 5).