Unusual case of dysphagia due to anomalous right subclavian artery

Translocating the aberrant right subclavian artery in dysphagia lusoria

“…Klinkhamer (1966) felt that the retrooesophageal artery is of clinical importance when the right carotid artery arises abnormally far away to the left in such a manner as to trap the somewhat flexible trachea and oesophagus and to prevent their anterior displacement at the crossing of the retro-oesophageal vessel. This is not generally accepted, however (Shumacker et al, 1971), and was not observed in our case. The mechanisms involved in the onset or aggravation of symptoms are also not understood.…”

“…The present case is of special interest in that pain, numbness of the left upper extremity and diminished radial pulse and blood pressure in the left instead of the right arm have never previously been reported in association with dysphagia lusoria. In the literature the classic description is of diminished radial pulse and blood pressure in the right rather than in the left arm (Felson et al, 1950;Shumacker et al, 1971). In the present case, since the aberrant right subclavian artery arose almost immediately behind the origin of the left subclavian artery, it might have exerted some pressure effect and impeded blood flow to the left arm.…”

“…Since intraoperative haemorrhage and damage to the adjacent nerves and thoracic duct are the possible hazards of operating in this area, the ideal approach to the aberrant artery will be an incision that provides good exposure and full control of the aberrant artery during dissection, division and anastomosis. We find that the mediastinal approach through a median sternotomy incision, as utilized by Shumacker et al (1971), satisfies these criteria. Early on in the operation the aberrant artery should be taped at its origin and to the right of the oesophagus.…”

“…The first report on re-establishing the continuity of the right subclavian artery after operation for dysphagia lusoria was described by Bailey et al in 1965. Following this, four new procedures for the treatment of dysphagia lusoria were described in the literature (Siderys, 1969;Pifarre et al, 1971;Shumacker et al, 1971 ;Orvald et al, 1972). The purpose of this communication is to describe a case of dysphagia lusoria with unusual symptoms treated by a revised technique of translocating the aberrant artery and to review the various reported surgical techniques of dividing and reconstituting the aberrant right subclavian artery in the treatment of dysphagia lusoria.…”

Dysphagia Lusoria with atrial septal defect: Simultaneous repair through midline

“…The median sternotomy approach was first described by Shumacker. [ 13 ] This approach is particularly beneficial if the patient has an associated intra-cardiac lesion, as in our patient. We believe that this is an ideal approach, as both the origin and the implantation sites are visualised satisfactorily, and bleeding can also be adequately controlled, with the possibility of institution of a cardiopulmonary bypass in case of inadvertent bleeding.…”