World Journal of Endocrine Surgery

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VOLUME 16 , ISSUE 2 ( May-August, 2024 ) > List of Articles

CASE REPORT

Aberrant Right Subclavian Artery and Relevance in Neck Surgery: A Case Report

Joycelyn Soo, Lydia Tan, Dilikua Pinto, Rajeev Parameswaran

Keywords : Case report, Subclavian artery, Thyroid parathyroid

Citation Information : Soo J, Tan L, Pinto D, Parameswaran R. Aberrant Right Subclavian Artery and Relevance in Neck Surgery: A Case Report. World J Endoc Surg 2024; 16 (2):48-52.

DOI: 10.5005/jp-journals-10002-1472

License: CC BY-NC 4.0

Published Online: 06-03-2025

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aberrant right subclavian artery (ARSA) is also known as “lusorial artery” and is a developmental anomaly whereby the artery courses posterior to the esophagus as a branch of the arch of the aorta. The condition is commonly associated with a nonrecurrent laryngeal nerve (NRLN). Here, we report three cases of ARSA associated with NRLN during thyroid and parathyroid surgery, detected during routine computerized tomography of the thorax. Patients commonly present with dysphagia, which can be disabling at times. In patients with severe symptoms associated with ARSA, vascular interventions may be required with open, thoracic endovascular aortic repair (TEVAR), or hybrid procedures.


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  1. Cairney J. The anomalous right subclavian artery considered in the light of recent findings in arterial development; with a note on two cases of an unusual relation of the innominate artery to the trachea. J Anat 1925;59(Pt 3):265–296. PMID: 17104060.
  2. Bae SB, Kang EJ, Choo KS, et al. Aortic arch variants and anomalies: embryology, imaging findings, and clinical considerations. J Cardiovasc Imaging 2022;30(4):231–262. DOI: 10.4250/jcvi.2022.0058
  3. Kau T, Sinzig M, Gasser J, et al. Aortic development and anomalies. Semin Intervent Radiol 2007;24(2):141–152. DOI: 10.1055/s-2007-980040
  4. Plotkin A, Ng B, Han SM, et al. Association of aberrant subclavian arteries with aortic pathology and proposed classification system. J Vasc Surg 2020;72(5):1534–1543. DOI: 10.1016/j.jvs.2020.01.042
  5. 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. DOI: 10.4103/2006-8808.147262
  6. Pramesh CS, Saklani AP, Parmar V, et al. Aberrant subclavian artery causing difficulty in transhiatal esophageal dissection. Dis Esophagus 2003;16(2):173–176. DOI: 10.1046/j.1442-2050.2003.00322.x
  7. Abboud B. Preoperative diagnosis of right nonrecurrent inferior laryngeal nerve by CT scan: report of a case and review of the literature. J Med Liban 2007;55(1):46–49. PMID: 17489307.
  8. Hermans R, Dewandel P, Debruyne F, et al. Arteria lusoria identified on preoperative CT and nonrecurrent inferior laryngeal nerve during thyroidectomy: a retrospective study. Head Neck 2003;25(2):113–117. DOI: 10.1002/hed.10180
  9. Watanabe A, Taniguchi M, Kimura Y, et al. Efficient, effective, safe procedure to identify nonrecurrent inferior laryngeal nerve during thyroid surgery. Head Neck 2016;38(4):573–577. DOI: 10.1002/hed.23932
  10. Polednak AP. Anatomical variation in the right non-recurrent laryngeal nerve reported from studies using pre-operative arterial imaging. Surg Radiol Anat 2019;41(8):943–949. DOI: 10.1007/s00276-019-02252-5
  11. Henry BM, Sanna S, Graves MJ, et al. The non-recurrent laryngeal nerve: a meta-analysis and clinical considerations. PeerJ 2017;5:e3012. DOI: 10.7717/peerj.3012
  12. Zheng V, Rajeev R, Pinto D, et al. Variant anatomy of non-recurrent laryngeal nerve: when and how should it be taught in surgical residency? Langenbecks Arch Surg 2023;408(1):185. DOI: 10.1007/s00423-023-02928-y
  13. Lynch J, Parameswaran R. Management of unilateral recurrent laryngeal nerve injury after thyroid surgery: a review. Head Neck 2017;39(7):1470–1478. DOI: 10.1002/hed.24772
  14. McDonald JJ, Anson BJ. Variations in the origin of arteries derived from the aortic arch, in American whites and Negroes. Am J Phys Anthropol 2005;27:91–107. DOI: 10.1002/ajpa.1330270129
  15. Polednak AP. Prevalence of the aberrant right subclavian artery reported in a published systematic review of cadaveric studies: the impact of an outlier. Clin Anat 2017;30(8):1024–1028. DOI: 10.1002/ca.22905
  16. 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. DOI: 10.1007/s00276-016-1796-5
  17. 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. DOI: 10.1002/uog.14774
  18. Momma K, Matsuoka R, Takao A. Aortic arch anomalies associated with chromosome 22q11 deletion (CATCH 22). Pediatr Cardiol 1999;20(2):97–102. DOI: 10.1007/s002469900414
  19. Tong E, Rizvi T, Hagspiel KD. Complex aortic arch anomaly: right aortic arch with aberrant left subclavian artery, fenestrated proximal right and duplicated proximal left vertebral arteries-CT angiography findings and review of the literature. Neuroradiol J 2015;28(4):396–403. DOI: 10.1177/1971400915598075
  20. Tamayo-Espinosa T, Erdmenger-Orellana J, Becerra-Becerra R, et al. Right-side aortic arch with aberrant left subclavian artery and Kommerell's diverticulum. A cause of vascular ring. Arch Cardiol Mex 2017;87(4):345–348. DOI: 10.1016/j.acmx.2017.03.006
  21. Cinà CS, Althani H, Pasenau J, et al. Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg 2004;39(1):131–139. DOI: 10.1016/j.jvs.2003.07.021
  22. Asherson N. David Bayford. His syndrome and sign of dysphagia lusoria. Ann R Coll Surg Engl 1979;61(1):63–67. PMID: 369446.
  23. Myers PO, Fasel JH, Kalangos A, et al. Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects. Ann Cardiol Angeiol (Paris) 2010;59(3):147–154. DOI: 10.1016/j.ancard.2009.07.008
  24. Natsis K, Lazaridis N, Gkiouliava A, et al. Retro-oesophageal right subclavian artery in association with thyroid ima artery: a case report, clinical impact and review of the literature. Folia Morphol (Warsz) 2016;75(1):130–135. DOI: 10.5603/FM.a2015.0080
  25. Inman JC, Kim P, McHugh R. Retroesophageal subclavian artery—esophageal fistula: a rare complication of a salivary bypass tube. Head Neck 2008;30(8):1120–1123. DOI: 10.1002/hed.20854
  26. Ikeda T, Yokota Y, Ando F, et al. A case of an aberrant subclavian artery-esophageal fistula due to prolonged nasogastric intubation. Kyobu Geka 1991;44(12):1045–1047. PMID: 1758110.
  27. Toniato A, Mazzarotto R, Piotto A, et al. Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg 2004;28(7):659–661. DOI: 10.1007/s00268-004-7197-7
  28. Kato K, Toriumi Y, Kamio M, et al. Nonrecurrent inferior laryngeal nerves and anatomical findings during thyroid surgery: report of three cases. Surg Case Rep 2016;2:44. DOI: 10.1186/s40792-016-0170-5
  29. Konishi T, Fukushima A, Watanabe S, et al. Two cases of nonrecurrent inferior laryngeal nerve—different branching levels from vagus nerve. J UOEH 2005;27(1):89–95. DOI: 10.7888/juoeh.27.89
  30. Jain KK, Braze AJ, Shapiro MA, et al. Aberrant right subclavian artery-esophageal fistula and severe gastrointestinal bleeding after surgical correction of scimitar syndrome. Tex Heart Inst J 2012;39(4):571–574. PMID: 22949782.
  31. Desvant C, Chevalier D, Mortuaire G. Tracheotomy bleeding from an unusual tracheo-arterial fistula: involvement of an aberrant right subclavian artery. J Laryngol Otol 2010;124(12):1333–1336. DOI: 10.1017/S0022215110001362
  32. Bozzani A, Sterpetti AV, Ragni F. Aberrant right subclavian artery: multiple solutions for a complex anomaly of the aortic arch. Ann Thorac Surg 2022;114(3):1091–1092. DOI: 10.1016/j.athoracsur.2021.07.054
  33. 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. DOI: 10.1016/j.jvs.2021.11.051
  34. Dueppers P, Floros N, Schelzig H, et al. Contemporary surgical management of aberrant right subclavian arteries (arteria lusoria). Ann Vasc Surg 2021;72:356–364. DOI: 10.1016/j.avsg.2020.08.151
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