Online first
Case report
Published online: 2024-08-20
Unusual morphology of an aberrant right subclavian artery: a case report and systematic review of cadaveric studies
DOI: 10.5603/fm.99244
Pubmed: 39192701
Abstract
Background: An aberrant right subclavian artery (ARSA) is a rare vascular anomaly defined by the origin of the right subclavian artery from the aorta, distal to the left subclavian artery (LSA). An ARSA was found in an 83-year-old female during cadaveric dissection for anatomy teaching, which had an unusually narrow lumen compared to previously reported cases.
Materials and methods: The specific morphology of this ARSA variant was characterised by further dissection and measurements. A systematic review of cadaveric case reports with quantitative evaluation of ARSA dimensions was conducted for comparison with this case.
Results: This ARSA variant exhibited an unusually narrow lumen (8.22 mm2) compared to the LSA (152.552), with an ARSA: LSA ratio of 0.24. The systematic review included 17 studies with 23 cases of ARSAs. Of these cases, 20 contained details of ARSA diameter, 19 of which were wider than in this case. In all studies where both ARSA and LSA diameters were measured, ARSA was found to be significantly wider than LSA (mean ratio of ARSA to LSA: 1.49, range: 1.09–2.00). Several other variations were reported in these studies, such as concomitant aortic arch branch anomalies and differing origins of ARSA as defined by vertebral level and relation to the aortic arch.
Conclusions: This case report presents an unusually narrow ARSA which has not been previously described in the literature. As there is limited evidence on how ARSA morphology affects clinical outcomes, further research is needed to better inform management of ARSAs.
Keywords: aberrant right subclavian arteryarteria lusoriamorphologydysphagiasubclavian steal
References
- Alghamdi MA, Al-Eitan LN, Elsy B, et al. Aberrant right subclavian artery in a cadaver: a case report of an aortic arch anomaly. Folia Morphol. 2021; 80(3): 726–729.
- Almenar-García V, Terol FF, Correa-Lacarcel J, et al. Retro-esophageal subclavian artery: a case report. Surg Radiol Anat. 2002; 24(3-4): 231–234.
- Asherson N. David Bayford; His syndrome annd sign of dysphagia lusoria. Ann R Coll Surg Eng. 1979; 61(1): 63–67.
- Barral JP, Croibier A. The subclavian arteries. In: Barral JP, Croibier A. ed. Visceral vascular maniulations. Churchill Livingstone, Edinburgh 2011: 110–116.
- Brownstein AJ, Rajaee S, Erben Y, et al. Natural history of aneurysmal aortic arch branch vessels in a single tertiary referral center. J Vasc Surg. 2018; 68(6): 1631–1639.e1.
- Buffoli B, Verzeletti V, Hirtler L, et al. Retroesophageal right subclavian artery associated with a bicarotid trunk and an ectopic origin of vertebral arteries. Surg Radiol Anat. 2021; 43(9): 1491–1495.
- Choi Y, Chung SB, Kim MS. Prevalence and anatomy of aberrant right subclavian artery evaluated by computed tomographic angiography at a single institution in Korea. J Korean Neurosurg Soc. 2019; 62(2): 175–182.
- Cortés P, Harris DM, Stancampiano FF, et al. Clinical characteristics and computed tomography findings in adult patients with an aberrant right subclavian artery: a single-center retrospective cohort study. J Comput Assist Tomogr. 2023; 47(3): 382–389.
- Coşkun E, Altınay L, Tekin A, et al. Aberrant right subclavian artery (arteria lusoria) aneurysm with a Kommerell's diverticulum. J Vasc Bras. 2019; 18: e20180091.
- Delap TG, Jones SE, Johnson DR. Aneurysm of an aberrant right subclavian artery presenting as dysphagia lusoria. Ann Otol Rhinol Laryngol. 2000; 109(2): 231–234.
- Dong S, Alarhayem AQ, Meier G, et al. Contemporary management and natural history of aberrant right subclavian artery. J Vasc Surg. 2022; 75(4): 1343–1348.e2.
- Epstein DA, Debord JR. Abnormalities associated with aberrant right subclavian arteries-a case report. Vasc Endovascular Surg. 2002; 36(4): 297–303.
- Esumi S, Kumagai Y, Koba Y, et al. Analysis of the regional anatomy of the retro-oesophageal right subclavian artery and surrounding structures. Folia Morphol. 2024; 83(1): 44–52.
- Fazan V, Ribeiro R, Ribeiro J, et al. Right retroesophageal subclavian artery. Acta Cirurgica Brasileira. 2003; 18(suppl 5): 54–56.
- GROSS RE, Gross RE. Surgical treatment for dysphagia lusoria. Ann Surg. 1946; 124(3): 532–534.
- Iwanaga J, Singh V, Takeda S, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
- Jalaie H, Grommes J, Sailer A, et al. Treatment of symptomatic aberrant subclavian arteries. Eur J Vasc Endovasc Surg. 2014; 48(5): 521–526.
- Janssen M. Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy. American J Gastroenterol. 2000; 95(6): 1411–1416.
- Kahraman H, Ozaydin M, Varol E, et al. The diameters of the aorta and its major branches in patients with isolated coronary artery ectasia. Tex Heart Inst J. 2006; 33(4): 463–468.
- Kaidoh T, Inoué T. Simultaneous occurrence of an aberrant right subclavian artery and accessory lobe of the liver. Anat Sci Int. 2011; 86(3): 171–174.
- Kikkeri NS, Nagalli S. Subclavian steal syndrome. StatPearls Publishing, Treasure Island 2023.
- Kimyaghalam A, Gabay A, Singh K. Aberrant right subclavian artery: a case of vertebrobasilar insufficiency. J Surg Case Rep. 2023; 2023(4): rjad199.
- Klinkhamer AC. A berrant right subclavian artery. Clinical and roentgenologic aspects. Am J Roentgenol Radium Ther Nucl Med. 1966; 97(2): 438–446.
- Krupiński M, Irzyk M, Moczulski Z, et al. CT evaluation of aberrant right subclavian artery: anatomy and clinical implications. Cardiol Young. 2019; 29(2): 128–132.
- Levitt B, Richter JE. Dysphagia lusoria: a comprehensive review. Dis Esophagus. 2007; 20(6): 455–460.
- Loschi D, Santoro A, Rinaldi E, et al. A systematic review of open, hybrid, and endovascular repair of aberrant subclavian artery and Kommerell's diverticulum treatment. J Vasc Surg. 2023; 77(2): 642–649.e4.
- Mahmodlou R, Sepehrvand N, Hatami S. Aberrant right subclavian artery: a life-threatening anomaly that should be considered during esophagectomy. J Surg Tech Case Rep. 2014; 6(2): 61–63.
- Makgalwa MP, Lebona GT, Human HR, et al. Aberrant right subclavian artery: a case report. Clin Anat. 2008; 21(4): 355–362.
- Mirande MH, Durhman MR, Smith HF. Anatomic investigation of two cases of aberrant right subclavian artery syndrome, including the effects on external vascular dimensions. Diagnostics (Basel). 2020; 10(8).
- Müller M, Schmitz BL, Pauls S, et al. Variations of the aortic arch — a study on the most common branching patterns. Acta Radiol. 2011; 52(7): 738–742.
- Namking M, Woraputtaporn W, Chaisiwamongkol K, et al. Anomalous origin of the right subclavian artery associated with right-sided thoracic duct: a case report. Srinagarind Med J. 2009; 24(1): 60–63.
- Naqvi SE, Beg MH, Thingam SK, et al. Aberrant right subclavian artery presenting as tracheoesophagial fistula in a 50-year-old lady: Case report of a rare presentation of a common arch anomaly. Ann Pediatr Cardiol. 2017; 10(2): 190–193.
- Nasser M, Petrocheli BB, Felippe TK, et al. Aberrant right subclavian artery: case report and literature review. J Vasc Bras. 2023; 22: e20210151.
- Natsis K, Didagelos M, Gkiouliava A, et al. The aberrant right subclavian artery: cadaveric study and literature review. Surg Radiol Anat. 2017; 39(5): 559–565.
- Natsis K, Didagelos M, Manoli SM, et al. A bicarotid trunk in association with an aberrant right subclavian artery. Report of two cases, clinical impact, and review of the literature. Folia Morphol. 2011; 70(2): 68–73.
- Ostrowski P, Bonczar M, Przybycień W, et al. An aberrant right subclavian artery in a 63-year-old male cadaver. Folia Morphol. 2023; 82(3): 726–731.
- Peña E, Zúñiga J, Baena G. Simultaneous occurrence of three anatomical variations: anomalous right subclavian artery, non-recurrent inferior laryngeal nerve and right thoracic duct. Int J Morphol. 2013; 31(4): 1181–1184.
- Polguj M, Chrzanowski Ł, Kasprzak JD, et al. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations — a systematic study of 141 reports. Sci World J. 2014; 2014: 292734.
- Puri SK, Ghuman S, Narang P, et al. CT and MR angiography in dysphagia lusoria in adults. Indian J Radiol Imaging. 2005; 15(4): 497–501.
- Qiu Y, Wu X, Zhuang Z, et al. Anatomical variations of the aortic arch branches in a sample of Chinese cadavers: embryological basis and literature review. Interact Cardiovasc Thorac Surg. 2019; 28(4): 622–628.
- Sakuma E, Kato H, Honda N, et al. The co-existence of an aberrant origin of the right subclavian artery and a coronary myocardial bridge. Folia Morphol. 2005; 64(2): 109–114.
- Sangam MR, Anasuya K. Arch of aorta with bi-carotid trunk, left subclavian artery, and retroesophageal right subclavian artery. Folia Morphol. 2010; 69(3): 184–186.
- Scala C, Leone Roberti Maggiore U, Candiani M, et al. Aberrant right subclavian artery in fetuses with Down syndrome: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015; 46(3): 266–276.
- Suriyonplengsaeng C, Meemon K. Retro-oesophageal right subclavian artery associated with a non-recurrent laryngeal nerve — case report. Eur J Anat. 2014; 18(1): 38–41.
- Troisi N, Chisci E, Ercolini L, et al. Simultaneous hybrid treatment of aneurysmal aberrant right subclavian artery. J Card Surg. 2015; 30(1): 80–84.
- Ulger Z, Ozyürek AR, Levent E, et al. Arteria lusoria as a cause of dysphagia. Acta Cardiol. 2004; 59(4): 445–447.
- van Son JA, Julsrud PR, Hagler DJ, et al. Surgical treatment of vascular rings: the Mayo Clinic experience. Mayo Clin Proc. 1993; 68(11): 1056–1063.
- van Son JA, Mierzwa M, Mohr FW. Resection of atherosclerotic aneurysm at origin of aberrant right subclavian artery. Eur J Cardiothorac Surg. 1999; 16(5): 576–579.
- Wang P, Wang Q, Bai C, et al. Iatrogenic aortic dissection following transradial coronary angiography in a patient with an aberrant right subclavian artery. J Int Med Res. 2020; 48(8): 300060520943789.
- Wysiadecki G, Varga I, Klejbor I, et al. Reporting anatomical variations: Should unified standards and protocol (checklist) for anatomical studies and case reports be established? Transl Res Anat. 2024; 35: 100284.
- Yang C, Shu C, Li M, et al. Aberrant subclavian artery pathologies and Kommerell's diverticulum: a review and analysis of published endovascular/hybrid treatment options. J Endovasc Ther. 2012; 19(3): 373–382.
- Zhao Z, Gu J. Open surgery in the era of minimally invasive surgery. Chin J Cancer Res. 2022; 34(1): 63–65.
