Surgical repair of aberrant subclavian artery through clamshell approach.

Aberrant subclavian artery is a rare abnormality that often occurs in association with Kommerell's diverticulum. The optimal surgical treatment is exclusion and reconstruction of the dilated diverticulum or aberrant subclavian artery. To accomplish such a radical operation in a single stage, we have introduced total (or partial) arch replacement using deep hypothermic circulatory arrest and the arch-first technique through a bilateral submammary thoracotomy (the clamshell approach). This technique provides excellent exposure of the neck arteries and the entire thoracic aorta.