Rare Case of a Five‐Branched Aortic Arch Exhibiting a Retroesophageal Right Subclavian Artery and an Accessory Left Vertebral Artery

Abstract

Head and neck vascular variations are common in human beings, but often go undetected. They are generally asymptomatic. Awareness of such anatomical variations is clinically important for surgeons and interventional radiologists as they may pose risk for iatrogenic complications or even the potential for unanticipated fatalities.Although aortic arch variations are relatively common in human fetuses, variations of its branches, i.e. the brachiocephalic trunk, the subclavian arteries, the vertebral arteries, and the common carotid arteries, are observed and/or described variably and fairly infrequently during human cadaveric dissection.When aberrant subclavian arteries are described in adults, they frequently involve the right side and are usually retroesophageal. In such cases, the right brachiocephalic trunk is absent. The following four branches of the aortic arch found most commonly then are: a left subclavian artery, an aberrant left vertebral artery, and right and left common carotid arteries. During cadaveric dissection of a 76 year‐old White male, we observed an additional fifth branch: an accessory left vertebral artery. A combination of five such aortic arch vessels in a single individual may be rare.Disclaimer: The opinions or assertions contained herein are the private ones of the author/speaker and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Overall Prevalence and Clinical Significance of a Retroesophageal Right Subclavian with a Non-Recurrent Right Laryngeal Nerve in an 83-year-old and a 93-year-old White Male Donor

“…During routine anatomical dissection of 260 human donors during the 2018-2023 medical and graduate nursing school anatomy courses at the Uniformed Services University of the Health Sciences (USUHS), three cases of a RRSA were identified. Granite et al (2018) published on a five branched aortic arch exhibiting a retroesophageal right subclavian artery and an accessory left vertebral artery found with a 76-year-old White male donor [10]. Here we describe two additional cases discovered since the time of that publication.…”

“…The left fourth aortic arch persists to give rise to the medial portion of the arch of the aorta, while the right fourth aortic arch regresses to contribute to the proximal RSA. Occasionally, however, this right fourth aortic arch fails to undergo its normal regression and leads to the development of ARSA variants, such as the RRSA [10,11]. This variant is typically asymptomatic or with symptoms appearing later in life [8,10].…”

“…Occasionally, however, this right fourth aortic arch fails to undergo its normal regression and leads to the development of ARSA variants, such as the RRSA [10,11]. This variant is typically asymptomatic or with symptoms appearing later in life [8,10]. It is the most common vascular ring anomaly and can cause symptoms of dyspnea, dysphagia, cough, stridor, thoracic pain, and pneumonia, usually secondary to compression of the esophagus or trachea.…”

“…RRSA, a specific subset of ARSA, has been estimated to occur in 1-3% of the overall population [1]. During examination of 260 cadavers at USUHS a total of three RRSA have been identified, representing a 1.15% prevalence [10].…”