Symptomatic Aberrant Right Subclavian Artery: Advantages of a Less Invasive Surgical Approach

Anatomic Investigation of Two Cases of Aberrant Right Subclavian Artery Syndrome, Including the Effects on External Vascular Dimensions

“…However, a more recent study showed that while 71.2% of their 141 ARSA cases reported dysphagia as a symptom, only 19.2% (27/141) possessed the bicarotid morphology [8]. In addition, in many cases of a BCT co-occurring with an ARSA, barium-contrast examination indicates that the esophagus is compressed posteriorly and obliquely at the level of the aorta [3,4,6,9,15,[18][19][20], suggesting that the ARSA is the primary contributor to esophageal compression and resulting dysphagia. There are also documented cases in which a BCT is absent or extremely mild, but dysphagia still presents [19,21].…”

“…Patients presenting with symptoms related to compression of the esophagus or trachea, and those with aneurysmal dilation or a KOD may require surgical intervention [1,[4][5][6]. A key issue in deciding on treatment type depends on whether an accompanying aneurysm is present [10].…”

“…A key issue in deciding on treatment type depends on whether an accompanying aneurysm is present [10]. If the ARSA is non-aneurysmal, then the goal of surgical treatment is the closure of the ARSA at its origin and the revascularization of the right subclavian artery via a transposition of the ARSA to the right common carotid artery [4,10].…”

“…The retroesophageal aberrant right subclavian artery (ARSA) or arteria lusoria is a vascular morphology that has been periodically reported in the literature and represents the most common aortic arch anomaly [1,2]. The ARSA represents about 17% of aortic malformations [1,3], has an incidence of 0.2-2.5% [1,4,5], a prevalence of 0.7-2.0% [6] and has a female predominance [6][7][8]. Clinical presentations of the ARSA include dysphagia (difficulty swallowing), dyspnea (labored breathing), chest pain, cough and weight loss [5].…”

“…The classic anatomic arrangement of the right subclavian artery is as a branch off the brachiocephalic trunk. However, in individuals with ARSA, the right subclavian artery branches directly off the posterior aortic arch (Figure 1) [1,[3][4][5]7,8]. This morphology affects its position and course relative to the mediastinal structures.…”