Aberrant subclavian artery

Aberrant subclavian artery
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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 vascular anomaly of the aortic arch,<ref name="Mahmodlou">,

 Aberrant Right Subclavian Artery: A Life-threatening Anomaly that should be considered during Esophagectomy, 
 Journal of Surgical Technique and Case Report, 
 
 Vol. 6(Issue: 2),
 pp. 61–63,
 DOI: 10.4103/2006-8808.147262,
 PMID: 25598945,
 PMC: 4290042,</ref> occurring in approximately 1% of individuals.<ref name="Mahmodlou" /><ref name="Kau" /><ref name="Chaoui" />

Presentation

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 extremity.<ref name="Kau">,

 Aortic Development and Anomalies, 
 Seminars in Interventional Radiology, 
 
 Vol. 24(Issue: 2),
 pp. 141–152,
 DOI: 10.1055/s-2007-980040,
 PMID: 21326792,
 PMC: 3036416,</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">, 
 Ortner's syndrome: a radiological diagnosis, 
 The Ulster Medical Journal, 
 
 Vol. 71(Issue: 1),
 pp. 55–56,
 
 PMID: 12137166,
 PMC: 2475354,</ref>

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"> St-Amant, Maxime. Kommerell diverticulum (right aberrant subclavian artery)(link). Radiopaedia.

Accessed 17 November 2017.

</ref><ref name="radiopaedia2"> Jha, Praveen. Kommerell diverticulum(link). Radiopaedia.

Accessed 17 November 2017.

</ref> It is alternatively known as a lusorian artery.<ref name="Mahmodlou" /><ref name="Chaoui" />

Pathophysiology

The embryological basis of the retroesophageal aberrant right subclavian artery

In the normal embryological development of the aortic arches, the right dorsal aorta regresses 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">,

 Aortic arch with four vessels: aberrant right subclavian artery, 
 Ultrasound in Obstetrics and Gynecology, 
 
 Vol. 31(Issue: 1),
 pp. 115–117,
 DOI: 10.1002/uog.5240,
 PMID: 18098341,</ref>

Treatment

Surgery is occasionally used to treat the condition.<ref name="pmid17382621">,

 Aberrant subclavian artery and Kommerell aneurysm: surgical treatment with a standard approach, 
 The Journal of Thoracic and Cardiovascular Surgery, 
 
 Vol. 133(Issue: 4),
 pp. 888–92,
 DOI: 10.1016/j.jtcvs.2006.12.005,
 PMID: 17382621,</ref>

Images

• 
  Aberrant subclavian artery at axial CT-scan. (1) trachea, (2) esophagus, (3) Aberrant subclavian artery.
• 
  Aberrant right subclavian artery at angiography.
• 
  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.
• 
  Aberrant subclavian artery seen at swallowing study: Impression of the esophagus from behind.

See also

• Dysphagia lusoria

External links

<references />