Surgical and Endovascular Treatment of Symptomatic Aberrant Right Subclavian Artery (Arteria Lusoria)

Reinhard Kopp; Ingrid Wizgall; Eckart Kreuzer; Georgios Meimarakis; Rolf Weidenhagen; Andreas Kühnl; Claudius Conrad; Karl Walter Jauch; Lutz Lauterjung

Disclosures

Vascular. 2007;15(2):84-91. 

In This Article

Abstract and Introduction

Abstract

Right aberrant subclavian artery, also called arteria lusoria, is one of the most common intrathoracic arterial anomalies. Although mostly asymptomatic, the retroesophageal and retrotracheal course of the lusorian artery might result in unspecific thoracic pain, dysphagia, dyspnea, arterioesophageal or arteriotracheal fistulae with hematemesis or hemoptysis, and aneurysmal formation with relevant risk of rupture. The purpose was to present our experience with six patients with a symptomatic aberrant right subclavian artery, two patients with dysphagia or dyspnea caused by a nonaneurysmal lusorian artery, and four patients with arteria lusoria aneurysms. The operative procedures performed are described and discussed in view of the data reported in the literature. According to the classification of the lusorian artery pathology, a combined intervention with right subclavian artery transposition, distal or proximal lusorian artery ligation or proximal endovascular occlusion for nonaneurysmal disease, or endovascular thoracic aortic stent graft implantation for lusorian artery aneurysms seems to be an additional and minimally invasive approach with promising midterm results.

Introduction

Right aberrant subclavian artery, also called arteria lusoria, is reported to be the most common intrathoracic abnormality of the aortic arch, with an incidence of 1 to 2%.[1]

Normally, the right subclavian artery develops from the fusion of the persistent right proximal dorsal aorta with the right seventh intersegmental artery distally. The abnormal origin of the right subclavian artery is caused by the involution of the right fourth vascular arch and proximal right dorsal aorta and the persistence of the seventh intersegmental artery originating from the proximal descending thoracic aorta, forming the aberrant course of the lusorian artery.[2,3]

Usually, individuals with an aberrant right subclavian artery are asymptomatic, but owing to the retroesophageal and retrotracheal course of the vessel, progressive dysphagia or dyspnea might occur.[3–5] The phenomenon of dysphagia lusoria was first reported in 1794 by Bayford.[6] Aneurysm formation is another complication in association with the abnormal course of the lusorian artery associated with a relevant risk of rupture and further compression of the esophagus or trachea.

Frequently, the arteria lusoria arises from an aortic arch diverticulum at the proximal descending aorta, first described by Kommerell.[7] This anatomic situation makes the proximal closure by simple ligation of the lusorian artery at its origin difficult. Therefore, various operative procedures have been described according to the underlying variable vascular pathology, with proximal occlusion of the lusorian artery either by a cervical approach, median sternotomy, or left- or right-sided thoracotomy, according to the side of the aortic arch, in combination with transposition of the right subclavian artery. In some patients, aortic cross-clamping with or without cardiopulmonary bypass was required.[1,5,8]

Recently, endovascular procedures or combined operative and endovascular treatment options (hybrid operation) have been reported for the management of disorders of the thoracic aorta and the supra-aortic vessels.[9–11] However, according to reports in the literature, so far only six patients with either dysphagia associated with a nonaneurysmal lusorian artery, a lusorian artery aneurysm, or ischemia owing to stenosis of the aberrant right subclavian artery were treated by endovascular procedures.[12–17]

We therefore report our six patients with a symptomatic aberrant right subclavian artery treated by different operative procedures, including open surgery, intraluminal endovascular treatment, and a combined surgical-endovascular approach (hybrid operation) with right subclavian artery transposition and thoracic aortic stent graft implantation.

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