An Aberrant Subclavian Artery Exhibiting the Partial Steal Phenomenon in a Patient with VACTERL Association

Abstract

We herein report the case of a 22-year-old Caucasian man with known vertebral defects, anal atresia, tracheoesophageal fistula with esophageal atresia, cardiac defects, renal and limb anomalies (VACTERL) association who presented with a headache and vertigo following the sudden and temporary loss of consciousness while attending a concert four days before admission to the hospital. On a physical examination, the following findings were found: a low body height, low-set ears, thoracic scoliosis and a mild holosystolic heart murmur. A neurosonological examination revealed a partial subclavian steal phenomenon. CT angiography of the neck vessels and aortic arch confirmed an anomalous right subclavian artery known as the lusorian artery. Further studies are warranted in patients with VACTERL in order to identify possible links between the prevalence of an aberrant right subclavian artery (lusorian artery) and possible congenital subclavian steal syndrome or dysphagia lusoria. In addition, duplex ultrasound of the carotid and vertebral arteries may be performed as part of screening examinations in patients with congenital syndromes.

Treatment of subclavian artery stenosis: A case series

“…It may also present as subclavian steal syndrome with symptoms of vertebro-basilar insufficiency as a result of retrograde flow in the ipsilateral vertebral artery [3] . The most common cause of subclavian artery stenosis is atherosclerosis but other causes include congenital abnormalities such as arteria lusoria (aberrant subclavian artery) or right sided aortic arch that can cause compression of the right subclavian artery leading to congenital subclavian steal syndrome [4] , [5] , [6] .…”

Revascularization of the Subclavian Artery

“…inflammatory diseases such as Takaysu's disease remains rare, especially in the elderly. A small percentage of etiology is represented by congenital malformations (arteria lusoria) [4]. Through this study, the authors have described the three methods of restoring blood flow to the upper limb in four patients with ischemic symptoms on subclavian stenosis.…”

Aberrant Right Subclavian Artery-Esophageal Fistula in 20-Year-Old with VATER Association

“…To our knowledge, in patients with VATER association, no case of fistulous connection has been reported, although one case of ARSA steal syndrome is found in the literature. 31 However, given the high frequency of ARSA in patients with EA, many cases may be underreported or unrecognized, particularly since ARSAesophageal fistula often results in sudden death without time for any diagnostic studies, and these patients often have other substantial comorbidities.…”