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| {{Infobox medical condition (new) | | {{Short description|Anatomical variant of the subclavian artery}} |
| | name = Aberrant subclavian artery | |
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| | image = Arteria lusoria MRA MIP-03 - Annotated.jpg
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| | caption = Aberrant subclavian artery on [[MR angiography]]. {{noprint|[[Commons:Category:Arteria lusoria MRA MIP Case 001|Scrollable version is available.]]}}
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| '''Aberrant subclavian artery''', or '''aberrant subclavian artery syndrome''', is a rare [[anatomical variant]] of the origin of the right or left [[subclavian artery]]. This [[abnormality]] is the most common [[Congenital disorder|congenital]] [[Blood vessel|vascular]] anomaly of the [[aortic arch]],<ref name="Mahmodlou">{{cite journal |last1= Mahmodlou|first1= Rahim|last2= Sepehrvand|first2= Nariman|last3=Hatami|first3=Sanaz|date= 2014|title=Aberrant Right Subclavian Artery: A Life-threatening Anomaly that should be considered during Esophagectomy |journal= Journal of Surgical Technique and Case Report|volume= 6|issue= 2|pages= 61–63|doi= 10.4103/2006-8808.147262|pmc=4290042|pmid=25598945}}</ref> occurring in approximately 1% of individuals.<ref name="Mahmodlou" /><ref name="Kau" /><ref name="Chaoui" />
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| ==Presentation== | | ==Aberrant Subclavian Artery== |
| This condition is usually [[asymptomatic]].<ref name="Mahmodlou" /> The aberrant artery usually arises just [[distal]] to the left subclavian artery and crosses in the posterior part of the [[mediastinum]] on its way to the right [[upper limb|upper extremity]].<ref name="Kau">{{cite journal |last1= Kau|first1= Thomas|last2= Sinzig|first2= Marietta|last3= Gasser|first3= Johann|last4= Lesnik|first4= Gerald|last5= Rabitsch|first5= Egon|last6= Celedin|first6= Stefan|last7= Eicher|first7= Wolfgang|last8= Illiasch|first8= Herbert|last9= Hausegger|first9= Klaus Armin|date= 2007|title= Aortic Development and Anomalies|journal= Seminars in Interventional Radiology|volume= 24|issue= 2|pages= 141–152|doi= 10.1055/s-2007-980040|pmc=3036416|pmid=21326792}}</ref> In 80% of individuals it crosses behind the [[esophagus]].<ref name="Kau" /> Such course of this [[aberrant]] [[vessel]] may cause a [[vascular]] ring around the [[trachea]] and esophagus. [[Dysphagia]] due to an aberrant right subclavian artery is termed [[dysphagia lusoria]], although this is a rare complication.<ref name="Kau" /><ref name="Chaoui" /> In addition to dysphagia, aberrant right subclavian artery may cause [[stridor]], [[dyspnoea]], [[chest pain]], or [[fever]].<ref name="Mahmodlou" /> An aberrant right subclavian artery may compress the [[recurrent laryngeal nerve]] causing a palsy of that nerve, which is termed [[Ortner's syndrome]].<ref name="Bickle">{{cite journal |last1= Bickle|first1= IC|last2= Kelly|first2= BE|last3= Brooker|first3= DS|date= 2002|title= Ortner's syndrome: a radiological diagnosis|journal= The Ulster Medical Journal|volume= 71|issue= 1|pages= 55–56|doi= |pmc=2475354|pmid=12137166}}</ref>
| | An '''aberrant subclavian artery''' is a rare anatomical variant of the [[subclavian artery]], which is one of the major arteries supplying blood to the [[upper limb]]. This condition is also known as "arteria lusoria" and is the most common congenital vascular anomaly of the aortic arch. |
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| The aberrant right subclavian artery frequently arises from a [[dilated]] segment of the proximal descending [[aorta]], the so-called Diverticulum of Kommerell (which was named for the German Radiologist, Burkhard Friedrich Kommerell (1901–1990), who discovered it in 1936).<ref name="radiopaedia1">{{cite web |url= https://radiopaedia.org/cases/kommerell-diverticulum-right-aberrant-subclavian-artery|title= Kommerell diverticulum (right aberrant subclavian artery)|last= St-Amant|first= Maxime|date= |website= Radiopaedia|publisher= |access-date= 17 November 2017|quote=}}</ref><ref name="radiopaedia2">{{cite web |url= https://radiopaedia.org/articles/kommerell-diverticulum|title= Kommerell diverticulum|last= Jha|first= Praveen|date= |website= Radiopaedia|publisher= |access-date= 17 November 2017|quote=}}</ref> It is alternatively known as a '''lusorian artery'''.<ref name="Mahmodlou" /><ref name="Chaoui" />
| | ==Anatomy== |
| | In a typical anatomical configuration, the [[subclavian arteries]] branch off from the [[brachiocephalic trunk]] on the right side and directly from the [[aortic arch]] on the left side. However, in the case of an aberrant subclavian artery, the right subclavian artery arises as the last branch of the aortic arch, distal to the left subclavian artery. It then courses behind the [[esophagus]] to reach the right arm. |
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| ==Pathophysiology== | | ==Embryology== |
| [[File:Aberrent right subclavian.png|thumb|The embryological basis of the retroesophageal aberrant right subclavian artery]]
| | The aberrant subclavian artery results from the abnormal regression of the fourth aortic arch during embryonic development. Normally, the right fourth aortic arch contributes to the formation of the right subclavian artery. In the case of an aberrant subclavian artery, the right fourth aortic arch regresses, and the artery develops from the right seventh intersegmental artery, leading to its aberrant course. |
| In the normal embryological development of the [[aortic arches]], the right [[dorsal aorta]] regresses [[Anatomical terms of location#Cranial and caudal|caudal]] to the origin of the 7th [[intersegmental artery]] which gives rise to the right [[subclavian artery]]. In formation of an aberrant right subclavian artery, the regression occurs instead between the 7th intersegmental artery and the right [[common carotid]] so that the right subclavian artery is then connected to the left [[dorsal]] aorta via the part of the right dorsal aorta which normally regresses. During growth, the origin of the right subclavian artery migrates until it is just distal to that of the left subclavian.<ref name="Chaoui">{{cite journal |last1= Chaoui|first1= R|last2= Rake|first2= A|last3= Heling|first3= KS|date= 2008|title= Aortic arch with four vessels: aberrant right subclavian artery|journal= Ultrasound in Obstetrics and Gynecology|volume= 31|issue= 1|pages= 115–117|doi= 10.1002/uog.5240|pmid= 18098341}}</ref>
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| ==Treatment== | | ==Clinical Significance== |
| Surgery is occasionally used to treat the condition.<ref name="pmid17382621">{{cite journal |vauthors=Kouchoukos NT, Masetti P |title=Aberrant subclavian artery and Kommerell aneurysm: surgical treatment with a standard approach |journal=The Journal of Thoracic and Cardiovascular Surgery |volume=133 |issue=4 |pages=888–92 |date=April 2007 |pmid=17382621 |doi=10.1016/j.jtcvs.2006.12.005 |doi-access=free }}</ref>
| | While many individuals with an aberrant subclavian artery are asymptomatic, some may experience symptoms due to compression of surrounding structures. This condition can lead to [[dysphagia]] (difficulty swallowing) when the artery compresses the esophagus, a condition known as "dysphagia lusoria." Other potential symptoms include [[chest pain]], [[cough]], and [[dyspnea]] (difficulty breathing). |
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| ==Images== | | ==Diagnosis== |
| <gallery>
| | The diagnosis of an aberrant subclavian artery is often made incidentally during imaging studies such as [[CT scan|computed tomography (CT)]] or [[MRI|magnetic resonance imaging (MRI)]] performed for other reasons. [[Barium swallow]] studies can also reveal the characteristic indentation on the esophagus caused by the aberrant artery. |
| File:Arteria lusoria Computertomographie.png|Aberrant subclavian artery at axial CT-scan. (1) trachea, (2) esophagus, (3) Aberrant subclavian artery.
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| File:Dysphagia lusoria.JPG|Aberrant right subclavian artery at angiography.
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| File:Arteria lusoria Breischluck ap.png|Tape-like impression of the esophagus caused by aberrant subclavian artery. Below (arrows) narrowing of the esophagus by a tumor that is causing the swallowing problems.
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| File:Arteria lusoria Breischluck.png|Aberrant subclavian artery seen at swallowing study: Impression of the esophagus from behind.
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| </gallery>
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| ==See also== | | ==Treatment== |
| | | Treatment is generally not required for asymptomatic individuals. However, in symptomatic cases, surgical intervention may be necessary. Surgical options include revascularization procedures to reposition the artery or relieve compression on the esophagus. |
| *[[Dysphagia lusoria]]
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| ==External links== | | ==Related Pages== |
| {{Medical resources
| | * [[Subclavian artery]] |
| | DiseasesDB =
| | * [[Aortic arch]] |
| | ICD10 = {{ICD10|Q|27|8|q|20}}
| | * [[Dysphagia]] |
| | ICD9 = {{ICD9|747.21 }}
| | * [[Vascular anomalies]] |
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| {{Congenital vascular defects}}
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| [[Category:Anatomical pathology]] | | [[Category:Vascular anomalies]] |
| [[Category:Congenital vascular defects]] | | [[Category:Congenital vascular disorders]] |
| <references />
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Anatomical variant of the subclavian artery
Aberrant Subclavian Artery
An aberrant subclavian artery is a rare anatomical variant of the subclavian artery, which is one of the major arteries supplying blood to the upper limb. This condition is also known as "arteria lusoria" and is the most common congenital vascular anomaly of the aortic arch.
Anatomy
In a typical anatomical configuration, the subclavian arteries branch off from the brachiocephalic trunk on the right side and directly from the aortic arch on the left side. However, in the case of an aberrant subclavian artery, the right subclavian artery arises as the last branch of the aortic arch, distal to the left subclavian artery. It then courses behind the esophagus to reach the right arm.
Embryology
The aberrant subclavian artery results from the abnormal regression of the fourth aortic arch during embryonic development. Normally, the right fourth aortic arch contributes to the formation of the right subclavian artery. In the case of an aberrant subclavian artery, the right fourth aortic arch regresses, and the artery develops from the right seventh intersegmental artery, leading to its aberrant course.
Clinical Significance
While many individuals with an aberrant subclavian artery are asymptomatic, some may experience symptoms due to compression of surrounding structures. This condition can lead to dysphagia (difficulty swallowing) when the artery compresses the esophagus, a condition known as "dysphagia lusoria." Other potential symptoms include chest pain, cough, and dyspnea (difficulty breathing).
Diagnosis
The diagnosis of an aberrant subclavian artery is often made incidentally during imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) performed for other reasons. Barium swallow studies can also reveal the characteristic indentation on the esophagus caused by the aberrant artery.
Treatment
Treatment is generally not required for asymptomatic individuals. However, in symptomatic cases, surgical intervention may be necessary. Surgical options include revascularization procedures to reposition the artery or relieve compression on the esophagus.
Related Pages
