Left Subclavian Artery Elongation Technique for a Child with a Vascular Ring

A 4-year-old girl with a vascular ring formed by a Right aortic arch, aberrant left subclavian artery, left ligamentum, and Kommerell diverticulum underwent surgical repair. Although she initially had only mild symptoms, imaging studies during follow-up revealed progressive tracheal compression. Preoperative computed tomography revealed in addition an anomalous origin of the left vertebral artery from the left common carotid artery. Division of the ligamentum, resection of the Kommerell diverticulum, and reimplantation of the left subclavian artery into the left common carotid artery were performed. The anomalous left vertebral artery originating from the left carotid artery meant that the left subclavian artery when reimplanted had to be situated more proximally. Because of this anatomic variant the left subclavian artery was elongated in order to reach the left carotid artery. We describe that elongation technique. Postoperative imaging confirmed improvement in tracheal compression and a patent left subclavain artery. This case highlights a variation in the origin of the left vertebral artery, which required left subclavian artery extension, and a more proximal anastomosis on the left carotid artery.