Abnormalities Associated with Aberrant Right Subclavian Arteries

Abstract

An aberrant right subclavian artery (ARSA) is an anomaly with a reported incidence of 0.5% to 2%. Usually the aberrant artery follows a retroesophageal course; rarely it takes a course anterior to the esophagus or the trachea. Most patients with an ARSA remain asymptomatic; however, progressive dysphagia develops occasionally. The choice of approach depends on the presence or absence of aneurysmal disease, the urgency of the operation, and the surgeon's experience. A case is reported of a 33-year-old white male patient who had a 3-year history of progressive dysphagia to the point that he was only able to swallow liquids. A barium swallow demonstrated a posterior extrinsic compression of the esophagus. Angiography was performed, which demonstrated an ARSA with a common origin of the right and left common carotid arteries. Surgical correction was performed via a right supraclavicular neck incision. The proximal aberrant artery was mobilized behind the esophagus. The distal, right subclavian artery was exposed, transected, and transposed with reimplantation into the right common carotid artery. An aberrant right thoracic duct was encountered and ligated. The English language literature from 1960 to present was reviewed via a Medline search. Reported anomalies associated with ARSAs include a nonrecurrent right inferior laryngeal nerve, a common origin of the common carotid arteries, a replaced right or left vertebral artery, coarctation of the aorta, a right-sided thoracic duct, and a right-sided aortic arch. It is important to be aware of these associated anomalies and how they impact the operative approach involved in the correction of dysphagia lusoria.

Anatomy and radiology of the variations of aortic arch branches in 1,266 patients

“…It courses posterior to the trachea and oesophagus, and hence its name: the retroesophageal RSCA. However, it may also extend between the trachea and oesophagus, or in front of the trachea [10,11,27]. We found it in 0.55% of the cases, which is within the reported range of 0.13% through 25% [6,11].…”

“…the alterations in their size or number, the absence of some vessels, their aberrant origin or position, or both. There are often various combinations of 2 or more aberrant arteries in the same patient A B [3,6,10,11]. Similarly, a combination of aberrations of both branches and the aortic arch variations can be observed, especially in patients with a double or a right-sided aortic arch [1,9,18,35].…”

Anomalous Origin of Bilateral Vertebral Arteries Associated with an Aberrant Right Subclavian Artery and a Common Carotid Trunk: Case Report

“…8 A vas cu lar ring ca u sed by an aber rant right subc la vi anar teryas so ci a tedwithacom monori gin ofthebothca ro tidar te ri esisra reanditsin ci dencemaybelessthan0.05%. 8,10 Theas so ci a ti onofan aber rantrightsubc la vi anar teryandacom moncaro tidtrunkcanbeexp la i nedbytheemb ryo lo gic do ub leaor ticarchre por tedbyEd wards,whodescri bedva ri o usaor ticarchab nor ma li ti esbyse lec tive reg res si on of va ri o us parts of each arch. An aber rantrightsubc la vi anar teryoc cursasare sultof thein ter rup ti onoftheemb ryo nicrightaor ticarch pro xi maltothese venthcer vi calin ter seg men talarteryandbothsi desofcom monca ro tidar te ri esarisefromtheaor ticsacwit ho utse pa ra ti onfromeach ot hertoformacom monori ginoftheca ro tidar teri es.…”

“…An aber rantrightsubc la vi anar teryoc cursasare sultof thein ter rup ti onoftheemb ryo nicrightaor ticarch pro xi maltothese venthcer vi calin ter seg men talarteryandbothsi desofcom monca ro tidar te ri esarisefromtheaor ticsacwit ho utse pa ra ti onfromeach ot hertoformacom monori ginoftheca ro tidar teri es. 10 Mostca seswithcom monca ro tidtrunkha ve nosymptomsex ceptforafewre por tedca sesofrespi ra torydis tressdu ringearlyin fancy.Res pi ra tory dis tress may be as cri bed to su pe ri or me di as ti nal crow dingandtrac he alcom pres si onbythecommonca ro tidtrunkfor minga'V'sha peinfrontof thetrac he aandrun ningalongbothsi des.Thetrac he alcom pres si onandres pi ra torydis tressmayimpro vewithagedu etoles se ningofthedeg re eof suchcrow ding.The reby,pa ti entswithan aber rant rightsubc la vi anar teryas so ci a tedwithcom moncaro tidtrunkmaybeasym pto ma ticorha vedysphagi aorres pi ra torysymptoms. [8][9][10][11] Ano ma lo us ori gin of the ver teb ral ar tery is onlypre sentin15.7%ofca seswithaber rantright subc la vi anar tery.…”

“…10 Mostca seswithcom monca ro tidtrunkha ve nosymptomsex ceptforafewre por tedca sesofrespi ra torydis tressdu ringearlyin fancy.Res pi ra tory dis tress may be as cri bed to su pe ri or me di as ti nal crow dingandtrac he alcom pres si onbythecommonca ro tidtrunkfor minga'V'sha peinfrontof thetrac he aandrun ningalongbothsi des.Thetrac he alcom pres si onandres pi ra torydis tressmayimpro vewithagedu etoles se ningofthedeg re eof suchcrow ding.The reby,pa ti entswithan aber rant rightsubc la vi anar teryas so ci a tedwithcom moncaro tidtrunkmaybeasym pto ma ticorha vedysphagi aorres pi ra torysymptoms. [8][9][10][11] Ano ma lo us ori gin of the ver teb ral ar tery is onlypre sentin15.7%ofca seswithaber rantright subc la vi anar tery. [11][12][13] Thecli ni calsig ni fi can ceof ano ma lo usver teb ralar teryori ginsisnotcle ar,yet inmostca sesdes cri bedintheli te ra tu re,ano ma lousver teb ralar teryori ginsdidnotre sultincli ni cal symptoms.The reareveryfewre portsdes cri bing pa ti entswhocomp la i nedofsymptomsofver tebro ba sil laryin suf fi ci ency.Kin kingofver teb ralarteryandin cre a sedin ci den ceofar te ri aldis sec ti on withano ma lo usori ginofthever teb ralar terywas al sore por ted.The o re ti cally,al te redhe mody na mics ca u setur bu len ce,whichmaypre dis po sethepa tientstoane urysms,andthe re fo rein cre a setherisk oface reb ro vas cu larac ci dent.Ho we ver,the reisno conc lu si veevi den cethatthe seva ri antsle adtoa pre dis po si ti ontoce reb ro vas cu lardi sor ders.…”