Hybrid Management of Dysphagia Lusoria with Tevar Implantation and Bilateral Subclavian Arteries Debranching: A Review of the Literature and a Case Report

Abstract

Aberrant right subclavian artery (ARSA) causing dysphagia, the so-called “dysphagia lusoria”, is a frequent embryologic anomaly of the aortic arch. In symptomatic patients, studies report several management options including surgical, hybrid, and totally endovascular strategies. Hybrid techniques have the advantage of no chest opening with reduced morbidity, but the problem of the ARSA stump causing recurrent or persistent dysphagia remains challenging in some cases. We conducted a literature review on the management strategies of ARSA and presented the case of a 72-year-old female patient with ARSA and dysphagia managed with thoracic endovascular repair of the aorta (TEVAR) and bilateral carotid–subclavian artery bypass. This technique was chosen because of the severe calcifications at the level of ARSA origin that would make surgical ligation difficult, or if an occluder device not suitable. We think that a patient-tailored approach should be considered in cases of dysphagia lusoria, considering that a multitude of strategies are reported.

Medical–Surgical Implications of Branching Variation of Human Aortic Arch Known as Bovine Aortic Arch (BAA)

“…There is a wide spectrum of aortic arch (AA) branching anomalies, some of which are clinically nonsymptomatic, and discovered incidentally during investigations for other pathologies. Others are clinically manifested by symptoms such as severe dyspnea associated with respiratory distress or "dysphagia lusoria" caused by esophageal compression [1]. In some cases, anatomical variations of the AA may occur alongside congenital cardiac anomalies or chromosomal genetic abnormalities [2,3].…”