Vascular rings in a tertiary care center: A retrospective review of clinical presentations and interventions

Figure 4 Three-dimensional computed tomography angiography of patient. A: Three-dimensional computed tomography angiography (CTA) reconstruction of patient 5 demonstrating the vascular anatomy in a patient with double aortic arch, showing both arches encircling the trachea and esophagus. Double aortic arch is the most common complete vascular ring; identifying the dominant vs nondominant arch on CTA is essential because it determines which arch segment is divided during surgical repair; B: Three-dimensional volume-rendered CTA demonstrating a right aortic arch with an aberrant left subclavian artery (ALSA) arising from a Kommerell diverticulum, with labeled branch vessels and the diverticulum origin of the ALSA. In a right aortic arch, identifying an ALSA arising from a Kommerell diverticulum is crucial because the diverticulum and retroesophageal ALSA can be the dominant compressive components; recognizing this anatomy preoperatively guides whether simple ligamentum division is sufficient or whether diverticulum/subclavian-directed intervention may be needed to prevent persistent symptoms. LAA: Left aortic arch; RAA: Right aortic arch; LCCA: Left common carotid artery; RCCA: Right common carotid artery; RSCA: Right subclavian artery; ALSC: Aberrant left subclavian.