Original Articles from the New England Society for Vascular Surgery
Aberrant right subclavian artery: Varied presentations and management options*

Presented at the Sixteenth Annual Meeting of the New England Society for Vascular Surgery, Bretton Woods, N.H., Sept. 21-22, 1989.
https://doi.org/10.1016/0741-5214(90)90078-OGet rights and content

Abstract

Although an aberrant right subclavian artery arising from the proximal portion of the descending thoracic aorta is the most common aortic arch anomaly, few patients have clinical symptoms directly attributable to it. When symptoms do occur they are usually causally related to aneurysmal or occlusive sequelae of atherosclerotic disease of the anomalous vessel. More unusual manifestations peculiar to the anomalous artery include aneurysmal degeneration of the origin of the vessel from the aortic arch, with its inherent risk of rupture, or symptoms of compression of the trachea or more commonly the esophagus by the anomalous vessel as it traverses the superior mediastinum. In patients with symptoms a variety of operative approaches and management strategies have been used. Our recent experience with treatment of two patients with clinical symptoms caused by an aberrant right subclavian artery illustrate the varied surgical options and prompted a review of the surgical management of this unusual anomaly. (J VASC SURG 1990;11:812-7.)

Section snippets

Case 1

A 32-year-old woman had an evaluation for a recent onset of dysphagia, which had slowly increased in severity. She also complained of a full sensation in her neck as though she had a “lump in her throat.”

On physical examination, she was found to be a healthy appearing 32-year-old woman with no contributing abnormalities. Pulse examination was normal with equal upper extremity blood pressures in both right and left arms. An upper gastrointestinal barium study was obtained and revealed a

Discussion

The first reported case of dysphagia caused by an aberrant right subclavian artery was by Hunauld2 in 1735 according to the earliest significant review of this anomaly in 1899 by Holzapfel.3 Bayford4 was the first to outline the anatomic abnormality and actually attribute it to the symptoms it may produce. He used the term dysphagia lusus naturae meaning dysphagia caused by a freak of nature. Since that time the term has been shortened to dysphagia lusoria. There were random reports in the

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    Because of their similar sizes, an aberrant right subclavian artery could, theoretically, be at the same risk as a left subclavian artery for the development of early symptomatic occlusive disease.9 Although ostial arteria lusoria stenosis has been described in the literature, it seems that occlusive disease of the aberrant subclavian artery tends to occur not at the ostium of the artery or at the vertebral artery origin, but at the point where the vessel passes between the esophagus and the vertebral column.8-10 These structures could cause mechanical stress that alters the local hemodynamics of the vessel wall promoting occlusive lesions.

  • Contemporary surgical approaches and outcomes in adults with kommerell diverticulum

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    In the few cases in which the patients had issues with transient nerve injury to the recurrent laryngeal nerve or phrenic nerve, they were allowed to recover completely before proceeding with the second-stage operation on the contralateral side. We have been reluctant to reconstruct the subclavian artery in the anomalous location out of concern for erosion, bleeding, or risk of dysphagia [2]. Our management of KD has evolved with time.

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*

Reprint requests: William M. Stone, MD, Mayo Clinic Scottsdale, 13400 E. Shea Blvd., Scottsdale, AZ 85259.

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