The problem of arteria lusoria in right transradial coronary angiography and angioplasty

Abstract

The retroesophageal right subclavian artery (arteria lusoria) is one of the anatomical abnormalities encountered by interventional cardiologists who perform right transradial procedures. We report on 11 patients with arteria lusoria in whom 14 right transradial coronary angiography or angioplasty procedures were attempted among a series of 3,730 consecutive right transradial attempts. This abnormality can be easily detected by angiographic visualization, in the anteroposterior projection, of the angle of the catheter when it engages the ascending aorta, and by manual angiography at the ostium of the right subclavian artery. In such a case, catheterization of the ascending aorta may be difficult or even impossible (7.1%). Selective catheterization of both coronary arteries is more difficult, takes longer, and requires more catheters. The Judkins catheters are recommended, although they are seldom used for the left coronary artery via the right radial approach, for both arteries. All catheter exchanges should be performed on long guidewires.

An Anomalous Right Subclavian Artery with a Retrotracheal Course: A Case Report

“…The asthma could possibly be due to anterior displacement of the trachea from RtRTSA. RtRTSA is also clinically important to the angiographer who uses the right axillary, brachial or radial approach to the ascending thoracic aorta [12,13]. Aberrant right subclavian artery could be the culprit in situations where catheterisation of the ascending aorta proves difficult [14].…”

Retro-oesophageal right subclavian artery in association with thyroid ima artery: a case report, clinical impact and review of the literature

“…The higher reported incidence with a wide range of 2.46-9.7% were found in African Americans by Bean (1905) and Loth (1912) as cited by De Garis et al [21], followed by Germans (4%) [55], Japanese (3.95%) [48] and South Africans (1.4%) [17]. Contrariwise, a very low incidence (0.30%) was detected in a European population [1]. The arteria lusoria is associated with other congenital anomalies, such as the formation of a bicarotid trunk (BCT), an aortic coarctation, a replaced right or left vertebral artery, a persistent left superior vena cava [72], a ventricular septal defect, the tetralogy of Fallot [44], pulmonary atresia and major aortico-pulmonary collateral arteries [40].…”

“…However when clinical manifestations occur, cardiac symptoms or silent ischaemia may appear [1] with prominent symptoms the progressive dysphagia and dyspnoea, particularly when the RERSA wall is calcified and the advanced atherosclerosis and hardening of the vessel compressing the oesophagus [34]. Persistent cough may be the main symptom due to the pulsatile action of the aberrant artery on the tracheal wall [57] or the compression exerted by an existing aneurysm on the adjacent structures.…”

Primary Percutaneous Coronary Intervention through Right Trans-Ulnar Access in a Case of Arteria Lusoria: Feasibility Stamped

“…The final result was satisfactory, with TIMI-3 flow, total pain relief, and resolution of STsegment elevation. Once the procedure ended, the introducer sheath was removed and hemostasis was achieved by using a compressive dressing with a porous elastic adhesive bandage for four hours [1][2][3][4][5][6].…”