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Gunga Z, Rousseau L, Wolff M, Rigollot A, Nowacka A, Dulgorov F, Ltaief Z, Rancati V, Trunfio R, Déglise S, Kirsch M. Case Report: Unlocking arteria Lusoria challenges: sternotomy's role in a single-stage aneurysm repair and artery realignment. Front Cardiovasc Med 2025; 12:1557293. [PMID: 40260107 PMCID: PMC12009874 DOI: 10.3389/fcvm.2025.1557293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 03/12/2025] [Indexed: 04/23/2025] Open
Abstract
Arteria lusoria (AL), an anomaly of the right subclavian artery, occurs in 2% of individuals and can cause symptoms such as dysphagia due to its retroesophageal course. Often associated with Kommerell's diverticulum (KD), a dilation at the artery's origin, this condition poses risks of rupture or dissection. Symptomatic cases and aneurysms necessitate surgical intervention, while asymptomatic cases may warrant observation. We present a case of a 44-year-old woman with dysphagia lusoria due to AL and KD, confirmed by imaging. Given anatomical complexities, a one-stage open surgical repair via sternotomy was performed. This involved resecting the KD and creating a neo-trajectory for the right subclavian artery using a Dacron tube graft. Cardiopulmonary bypass ensured safe manipulation, and post-operative imaging confirmed excellent outcomes, with complete symptom resolution. Surgical approaches for AL and KD vary depending on anatomy and symptomatology, ranging from open repairs to hybrid and endovascular techniques. Open thoracotomy remains the gold standard for young patients without comorbidities. Hybrid approaches are reserved for emergencies or high-risk patients, offering reduced morbidity but potentially higher complication rates. Advances in imaging and surgical techniques, including hybrid methods, have improved outcomes, with mortality rates significantly lower than historical benchmarks. The 2024 EACTS/STS guidelines recommend open surgery for young, fit patients (Class I, Level C) and hybrid approaches for emergencies or patients unfit for open surgery (Class I, Level C). Our case exemplifies the feasibility of sternotomy in providing precise, effective correction for KD with AL in a single operation while minimizing risks associated with other approaches.
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Affiliation(s)
- Ziyad Gunga
- Cardiac Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lorène Rousseau
- Cardiac Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Margaux Wolff
- Cardiac Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Augustin Rigollot
- Cardiac Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Anna Nowacka
- Cardiac Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Filip Dulgorov
- Cardiac Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Zied Ltaief
- Anesthesiology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Valentina Rancati
- Anesthesiology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Rafael Trunfio
- Vascular Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sebastien Déglise
- Vascular Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Matthias Kirsch
- Cardiac Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Lin RJ, Law KS, Wu PJ. Comprehensive Analysis of the Aberrant Right Subclavian Artery: A Perspective from a Single Institute. Diagnostics (Basel) 2025; 15:772. [PMID: 40150114 PMCID: PMC11941208 DOI: 10.3390/diagnostics15060772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Revised: 03/17/2025] [Accepted: 03/17/2025] [Indexed: 03/29/2025] Open
Abstract
Background/Objectives: This study aimed to provide a descriptive review of fetal aberrant right subclavian artery (ARSA), with a discussion of the genomic and structural anatomy and perinatal prognosis in our hospital's obstetric department. Methods: In total, 3266 fetal level II sonographies were performed between January 2020 and June 2023. The 21 cases diagnosed with ARSA were included in this study. Obstetric ultrasound screening, noninvasive prenatal screening, and fetal karyotyping were performed. Fetal echocardiograms, postnatal information, and follow-up data were recorded. Results: In our dataset of 3266 cases, the overall incidence rate of ARSA was 0.6%. Of the 21 fetuses with ARSA, no abnormalities were detected in either prenatal or genetic tests, and no chromosomal anomalies were identified. Conclusions: Our study provides informative insights into ARSA, emphasizing the need for a comprehensive evaluation of its structural and genetic aspects. The findings of this study prompt further exploration, especially regarding the increasing incidence of ARSA and the potential role of advanced genetic analyses in enhancing diagnostic precision and fetal prognostic evaluation.
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Affiliation(s)
- Rou Jiun Lin
- Department of Obstetrics and Gynecology, Tung’s Taichung Metroharbor Hospital, 699 Taiwan Boulevard, Taichung 435, Taiwan;
| | - Kim-Seng Law
- Department of Obstetrics and Gynecology, Tung’s Taichung Metroharbor Hospital, 699 Taiwan Boulevard, Taichung 435, Taiwan;
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, 145 Xingda Road, Taichung 402, Taiwan
| | - Pei-Jhen Wu
- Department of Medical Research, Tung’s Taichung Metroharbor Hospital, 699 Taiwan Boulevard, Taichung 435, Taiwan;
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Sun Y, Gu Y, Dong S, Huang L, Shao Z, Xu H, Du C, Dong J, Guo H. Midterm Outcome of Aortic Dissection Associated With Aberrant Subclavian Artery: A Single-Center Retrospective Observational Study. J Endovasc Ther 2024:15266028241307568. [PMID: 40165434 DOI: 10.1177/15266028241307568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
PURPOSE The aberrant subclavian artery (aSA) is a rare anomaly of the aortic branches. Approximately 20-60% of patients with an aSA are associated with Kommerell's diverticulum (KD). These vascular anomalies have been reported to increase the risk of aortic rupture (4-19%) and aortic dissection. However, limited studies have investigated the treatment of aortic dissection in patients with aSA and KD. This study aims to investigate clinical characteristics and midterm follow-up outcomes of patients with aortic dissection associated with aSA. MATERIALS AND METHODS Between 2011 and 2021, a total of 48 patients with aSA anomalies underwent aortic dissection surgical intervention. Surgical interventions include open surgery, hybrid surgery, and endovascular therapy. Among them, 20 (41.7%) had Stanford type A dissection, 9 (18.8%) had Stanford type B dissection, and 19 (39.6%) had non-A non-B dissection. We report the early and midterm clinical outcomes including mortality, central nervous system complication and respiratory complication, and other operative outcomes including reintervention rates and endoleak. A subgroup analysis of the surgical and postoperative conditions was performed on Stanford type B and non-A non-B aortic dissection patients. RESULTS The mean age of the patient population was 48.81±9.65 years. The 30-day mortality rate was 12.5%. The overall mortality rate was 20.8%, with a median follow-up time of 4.5 years (interquartile range [IQR]: 2-8.75 years). Central nervous system complications occurred in 8 patients (16.7%), subclavian steal syndrome in 6 patients (12.5%), and respiratory complications in 3 patients (6.2%). The estimated Kaplan-Meier survival rates at 1 year, 3 years, 5 years, and 7 years after surgery were, respectively, 87.0%, 82.5%, 79.7%, and 75.1%. For Stanford type B and non-A non-B aortic dissection patients, the 30-day mortality rate between the open surgery group and the minimally invasive group had no statistically significant differences (18.3% vs 8.3%, p=0.815). CONCLUSIONS Surgical intervention for aSA patients with aortic dissection has poor outcomes. Early intervention might be considered for patients with aSA and KD to prevent the occurrence of aortic dissection.Clinical ImpactAberrant subclavian artery (aSA) and Kommerell's diverticulum (KD) have been reported to increase the risk of aortic rupture and aortic dissection. This study is currently the largest single-center retrospective study on aSA combined with aortic dissection, providing standardized data reporting and midterm follow-up of patients with this rare vascular anomaly.
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Affiliation(s)
- Yangxue Sun
- Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanrui Gu
- Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuo Dong
- Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingchen Huang
- Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zehua Shao
- Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Xu
- Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuhao Du
- Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Dong
- Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwei Guo
- Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kordzadeh A, Mouhsen MI, Chan DM, Singh A, Gadhvi VM. Hybrid management of aberrant subclavian artery: A systematic review and meta-analysis. Vascular 2024:17085381241303330. [PMID: 39607853 DOI: 10.1177/17085381241303330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2024]
Abstract
OBJECTIVE To elucidate the short- and long-term mortality, morbidity, and endoleak incidences in the hybrid management of aberrant subclavian artery (ASA). METHODS A systematic review and meta-analysis of 99 articles comprising n = 272 cases using PRISMA were supplemented by Cohen's Kappa for assessor consistency. The analysis involved a random-effect model, odds ratios (ORs) with 95% confidence intervals, tests of heterogeneity, and probability. This review was registered with the International Prospective Register of Systematic Reviews (CRD42023405011). RESULTS The 30-day mortality was 4.6% (95% CI: 1.4%-14.4%) with an overall mortality of 7.3% (95% CI: 2.9%-18.7%) demonstrating a 1.2% increase in mortality per decade of life beyond 60 years. The reported morbidity was 7.6% (95% CI: 3.7%-15.7%) and higher in males albeit higher age (p < .05) (67 vs 59 years). The endoleak incidence stood at 7.8% (95% CI: 3.3%-18.3%) with Type-I the as prominent (48%). Rupture presentation was in 3%, whilst esophageal fistulation (n = 2/3) was associated with morbidity of 66%. Treatment varied, with TEVAR and carotid-subclavian bypass being the most common modality of the choice. The median follow-up was 12 months (IQR, 1-60 months). CONCLUSION The observed incidence of mortality, morbidity, and endoleak shows the current role of the hybrid approach in managing ASA. These results emphasize the critical role of detailed surgical planning, combined endovascular and open expertise, and the necessity for a common registry to monitor long-term outcomes.
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Affiliation(s)
- Ali Kordzadeh
- Mid & South Essex Hospital Services NHS Foundation Trust, Cardiovascular Department, Basildon and Thurrock University Hospital, Basildon, UK
| | - Mohamed Imm Mouhsen
- Mid & South Essex Hospital Services NHS Foundation Trust, Cardiovascular Department, Basildon and Thurrock University Hospital, Basildon, UK
| | - Deona Ml Chan
- Mid & South Essex Hospital Services NHS Foundation Trust, Cardiovascular Department, Basildon and Thurrock University Hospital, Basildon, UK
| | - Arvind Singh
- Mid & South Essex Hospital Services NHS Foundation Trust, Cardiovascular Department, Basildon and Thurrock University Hospital, Basildon, UK
| | - Vijay M Gadhvi
- Mid & South Essex Hospital Services NHS Foundation Trust, Cardiovascular Department, Basildon and Thurrock University Hospital, Basildon, UK
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Sormaz IC, Iscan AY, Tunca F, Kostek M, Aygun N, Matlim Ozel T, Soytas Y, Poyanli A, Sari S, Uludag M, Giles Senyurek Y. Electrophysiological monitoring of the nonrecurrent inferior laryngeal nerve and radiological evaluation of concurrent vascular anomalies. Front Endocrinol (Lausanne) 2024; 15:1420697. [PMID: 39371923 PMCID: PMC11449809 DOI: 10.3389/fendo.2024.1420697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 09/03/2024] [Indexed: 10/08/2024] Open
Abstract
Purpose The objective of this study was to characterize the electrophysiological characteristics of nonrecurrent inferior laryngeal nerves (NRILNs) that were dissected via intraoperative neuromonitoring (IONM) and concomitant vascular anomalies in patients with NRILNs. Methods A retrospective analysis was conducted on 7865 patients who underwent thyroidectomy with IONM at three tertiary referral centers. The study included 42 patients in whom an NRILN was detected. IONM data and postoperative vocal cord (VC) examinations were recorded for all patients. The absence of an initial vagal EMG response and/or a short (<3.5 ms) latency period during the initial vagal stimulation or the inability to identify the RLN within the Beahrs triangle was considered highly suspicious for the presence of an NRILN. Postoperative cross-sectional imaging was performed in 36 out of 42 patients to assess any concurrent vascular anomalies. Results The prevalence of NRILN was 0.53%. An NRILN was suspected due to EMG findings in 32 (76%) patients and the inability to identify the RLN within the Beahrs triangle in the remaining 10 (24%) patients. The mean right VN latency period was 3.05 ± 0.15 ms. The V1 latency period of the right VN was shorter than 3.5 ms in 39 (93%) and longer than 3.5 ms in 3 (7%) patients. One of these three patients with latency>3.5ms had a large mediastinal goiter. Transient VC paralysis occurred in one (2.4%) patient. Of the 36 patients with postoperative imaging data, 33 (91.4%) had vascular anomalies. All 33 patients had aberrant right subclavian arteries, and 13 (39.4%) also had accompanying additional vascular anomalies. Conclusion The NRILN is an anatomical variation that increases the risk of nerve injury. Observation of an absent EMG response and/or a short latency period during the initial vagal stimulation facilitates the detection of an NRILN at an early stage of thyroidectomy in the majority of patients.
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Affiliation(s)
- Ismail Cem Sormaz
- Division of Endocrine Surgery, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ahmet Yalin Iscan
- Division of Endocrine Surgery, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Fatih Tunca
- Division of Endocrine Surgery, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Mehmet Kostek
- Division of Endocrine Surgery, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Nurcihan Aygun
- Division of Endocrine Surgery, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Tugba Matlim Ozel
- Division of Endocrine Surgery, Department of General Surgery, Basaksehir Cam and Sakura City Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Yigit Soytas
- Division of Endocrine Surgery, Department of General Surgery, Basaksehir Cam and Sakura City Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Arzu Poyanli
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Serkan Sari
- Division of Endocrine Surgery, Department of General Surgery, Basaksehir Cam and Sakura City Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Mehmet Uludag
- Division of Endocrine Surgery, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Yasemin Giles Senyurek
- Division of Endocrine Surgery, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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Stiru O, Robu M, Platon P, Bubenek-Turconi SI, Iliescu VA, Parasca C. Hybrid Management of Dysphagia Lusoria with Tevar Implantation and Bilateral Subclavian Arteries Debranching: A Review of the Literature and a Case Report. J Pers Med 2024; 14:547. [PMID: 38929768 PMCID: PMC11204707 DOI: 10.3390/jpm14060547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024] Open
Abstract
Aberrant right subclavian artery (ARSA) causing dysphagia, the so-called "dysphagia lusoria", is a frequent embryologic anomaly of the aortic arch. In symptomatic patients, studies report several management options including surgical, hybrid, and totally endovascular strategies. Hybrid techniques have the advantage of no chest opening with reduced morbidity, but the problem of the ARSA stump causing recurrent or persistent dysphagia remains challenging in some cases. We conducted a literature review on the management strategies of ARSA and presented the case of a 72-year-old female patient with ARSA and dysphagia managed with thoracic endovascular repair of the aorta (TEVAR) and bilateral carotid-subclavian artery bypass. This technique was chosen because of the severe calcifications at the level of ARSA origin that would make surgical ligation difficult, or if an occluder device not suitable. We think that a patient-tailored approach should be considered in cases of dysphagia lusoria, considering that a multitude of strategies are reported.
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Affiliation(s)
- Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Pavel Platon
- Catheterization Laboratory, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Serban-Ion Bubenek-Turconi
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- 1st Department of Cardiovascular Anesthesiology and Intensive Care, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Catalina Parasca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
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Bizhga M, Velmishi V, Sila L, Koja A, Hoxha S. Dysphagia lusoria caused by aberrant right subclavian artery associated with truncus bicaroticus in an 8-month-old girl. Case report and review of literature. LA PEDIATRIA MEDICA E CHIRURGICA 2024; 46. [PMID: 38625064 DOI: 10.4081/pmc.2024.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Dysphagia lusoria is a rare pediatric condition caused by extrinsic compression of the esophagus by an abnormal subclavian artery. The most common congenital abnormality in aortic arch development is an aberrant right subclavian artery. The retroesophageal right subclavian artery is typically symptomatic in 10-33% of cases. The patient, an 8-month-old girl with a history of early dysphagia and stridor, was diagnosed with an abnormal right subclavian artery. She was admitted to the pneumology service multiple times due to stridor, vomiting, and failure to thrive. During hospitalization at the gastroenterology service, a barium swallow and an upper digestive endoscopy indicated an abnormal right subclavian artery, which was confirmed by an Angiography CT scan. She underwent surgery at the age of sixteen months. All symptoms are resolved following surgical intervention, and the patient is still asymptomatic and in good clinical condition 12 months later. Every physician should be aware of abnormal right subclavian arteries and their clinical symptoms in children and adults in order to recognize and diagnose them early. Only an early evaluation may reduce complications such as delayed physical growth, dysphagia, and recurrent respiratory infections.
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Affiliation(s)
- Melpomeni Bizhga
- Service of Pediatric Pneumology, Mother Teresa Hospital, Tirana.
| | - Virtut Velmishi
- Service of Pediatric Gastroenterology, Mother Teresa Hospital, Tirana.
| | - Lorena Sila
- Pediatric Department, Mother Teresa Hospital, Tirana.
| | - Albert Koja
- Service of Pediatric Cardiology, Mother Teresa Hospital, Tirana.
| | - Stiljan Hoxha
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona.
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Shamsodini J, Molnár D. A Computed Tomography Study on the Prevalence of Lusorian Artery Among Hungarian Adults. Cureus 2024; 16:e58622. [PMID: 38770487 PMCID: PMC11103453 DOI: 10.7759/cureus.58622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The aberrant right subclavian artery (ARSA), also called as lusorian artery (LA) is a developmental anomaly that exists in conjunction with a right non-recurrent laryngeal nerve (NRLN) in almost all cases. The average prevalence of such a vascular variation is estimated as 1%, although, studies have reported very different population means. Up to date, there is no available data on the frequency of this pattern in the Hungarian population. It can be treated as an indirect marker of a NRLN. Any preoperative information on the course of the inferior laryngeal nerves can help surgeons reduce the risk of an iatrogenic injury during thyroidectomies, especially in an environment where access to intraoperative neuromonitoring is limited. Objectives The primary aims were to determine the prevalence of an ARSA, predict the existence of an NRLN in the Hungarian population, and provide demographic analysis. Methods A retrospective, computed tomography-based study was carried out. Demographic description and statistical analysis were provided where applicable. Detected anomalous vasculatures were visualized with 3D segmentation, and images were interpreted. Results The imaging database review identified three patients with ARSA out of 686 eligible recordings, resulting in a frequency of 0.437% in the study population. All three patients were female and had a retroesophageal LA. Two of them had a Kommerell's diverticulum. One patient had common carotid arteries with a single origin. Conclusions The frequency of an ARSA and a concomitant NRLN among Hungarians fits into the results of recent meta-analyses. Preoperative assessment of this anomaly may reduce vocal cord complication rates of thyroidectomies.
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Affiliation(s)
- Julia Shamsodini
- Department of Otolaryngology, Semmelweis University, Budapest, HUN
| | - Dávid Molnár
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, HUN
- Department of Otorhinolaryngology and Head and Neck Surgery, Central Hospital of Northern Pest - Military Hospital, Budapest, HUN
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Valenzuela-Fuenzalida JJ, Orellana-Donoso M, Perez-Jiménez D, Farfán-Cabello E, Gold-Semmler M, Becerra-Farfan A, Román C, Nova-Baeza P. Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions. Medicine (Baltimore) 2024; 103:e36856. [PMID: 38394517 PMCID: PMC11309723 DOI: 10.1097/md.0000000000036856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/13/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A high incidence of anatomical variations in the origin of the branches of the aortic arch has been reported, Nowadays, this variation is considered the most frequent in the aortic arch, its prevalence being estimated between 0.5% and 2.5% of the population. To understand its origin, knowledge of embryonic development is necessary. METHODS We searched the MEDLINE, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Latin-American literature and caribean of health sciences databases with dates ranging from their inception to June 2023. Study selection, data extraction, and methodological quality were assessed with the guaranteed tool for anatomical studies (Anatomical Quality Assurance). Finally, the pooled prevalence was estimated using a random effects model. RESULTS Thirty-nine studies were found that met the eligibility criteria. Twenty studies with a total of 41,178 subjects were included in the analysis. The overall prevalence of an ARSA variant was 1% (95% confidence interval = 1%-2%), the clinical findings found are that if ARSA is symptomatic it could produce changes in the hemodynamic function of the thoracocervical region in addition to other associated symptomatic complications in surrounding structures. CONCLUSIONS ARSA can cause several types of alterations in the cervical or thoracic region, resulting in various clinical complications, such as lusory dysphagia. Hence, knowing this variant is extremely important for surgeons, especially those who treat the cervico-thoracic region. The low prevalence of ARSA means that many professionals are completely unaware of its existence and possible course and origin. Therefore, this study provides detailed knowledge of ARSA so that professionals can make better diagnoses and treatment of ARSA.
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Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Mathias Orellana-Donoso
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Daniela Perez-Jiménez
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Emilio Farfán-Cabello
- Departamento de Anatomía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marjorie Gold-Semmler
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Alvaro Becerra-Farfan
- Departamento de Ciencias Química y Biológicas Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins
| | - Camila Román
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Pablo Nova-Baeza
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
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Nguyen D, Leon LR, Berman SS. Hybrid repair of aberrant right subclavian artery using open and endovascular techniques. J Vasc Surg Cases Innov Tech 2023; 9:101307. [PMID: 37771729 PMCID: PMC10522982 DOI: 10.1016/j.jvscit.2023.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/09/2023] [Indexed: 09/30/2023] Open
Abstract
An aberrant right subclavian artery, the most common anatomic variant of the aortic arch, occurs in 0.5% of the population. Symptoms generally result from compression of the esophagus and/or trachea as the aberrant vessel passes posteriorly in the mediastinum. Treatment includes revascularization of the right subclavian artery from the right common carotid artery using a cervical approach combined with occlusion of the origin of the aberrant vessel from the thoracic aorta. We describe a hybrid treatment approach for a symptomatic aberrant right subclavian artery using cervical revascularization and branched thoracic stent graft coverage of the origin of the aberrant vessel.
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Affiliation(s)
- Daniel Nguyen
- College of Medicine, The University of Arizona, Tucson, AZ
| | - Luis R. Leon
- Pima Heart and Vascular, Tucson, AZ
- Section of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - Scott S. Berman
- Pima Heart and Vascular, Tucson, AZ
- Section of Vascular Surgery, The University of Arizona, Tucson, AZ
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11
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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12
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Jones EL, Riangwiwat T, Blankenship JC. A Simple Method to Diagnose Arteria Lusoria During Right Radial Access Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S227-S229. [PMID: 35868996 DOI: 10.1016/j.carrev.2022.06.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/06/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022]
Abstract
Arteria lusoria (aberrant right subclavian artery) occurs in approximately 0.1-2.4 % of all individuals. The resulting tortuosity can pose a challenge for coronary angiography using radial artery access, but also can aid in the diagnosis if not already established. This case series reports three patients diagnosed with arteria lusoria by a single low-volume catheterization operator over a 6-month period, noting that its prevalence may be higher than usually reported, can be suspected when a catheter from the right radial artery crosses the midline and forms a loop as it traverses to the ascending aorta, and that it does not preclude successful catheterization and coronary intervention.
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Affiliation(s)
- Erika L Jones
- Division of Cardiology, University of New Mexico, Albuquerque, NM, United States of America
| | - Tanawan Riangwiwat
- Department of Cardiology, Geisinger Medical Center, Danville, PA, United States of America
| | - James C Blankenship
- Division of Cardiology, University of New Mexico, Albuquerque, NM, United States of America.
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13
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Tesfaye W, Mekonen A, Feyisa M, Kassa S. Transhiatal esophagectomy on a patient with aberrant right subclavian artery: A case report. Int J Surg Case Rep 2023; 108:108438. [PMID: 37406530 PMCID: PMC10382764 DOI: 10.1016/j.ijscr.2023.108438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Esophageal dissection is generally safe and easy during transhiatal esophagectomy (THE). The right subclavian artery crosses between the esophagus and spine in about 1 % to 2 % of cases. This condition is called aberrant right subclavian artery and is the most common congenital aortic arch anomaly. Pre-operative recognition of this anomaly is important in esophageal surgeries. In unprepared situations injury to this vessel may result in life threatening bleeding. CASE PRESENTATION A 45 year old female patient presented with progressive dysphagia and weight loss. Esophageal mass was found during upper gastrointestinal endoscopy. Additionally, a CT scan of the thorax and abdomen revealed an aberrant right subclavian artery and a distal esophageal mass. Biopsy revealed squamous cell carcinoma. A transhiatal esophagectomy was performed successfully with no complications. DISCUSSION The vast majority of patients with an aberrant right subclavian artery do not experience any symptoms. In rare cases, patients may present with dysphagia (dysphagia lusoria) and obstructive respiratory symptoms in their fourth or fifth decade. When patients present with dysphagia from esophageal cancer, careful review of imaging is needed to identify the aberrant artery. CONCLUSION The presence of aberrant right subclavian artery causes difficulty in performing esophagectomy. If it is diagnosed preoperatively, cautious retroesophageal dissection prevents injury to this vessel and complications following it.
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Affiliation(s)
- Workneh Tesfaye
- Cardiothoracic Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Ethiopia.
| | - Abenezer Mekonen
- Cardiothoracic Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Mekonnen Feyisa
- Cardiothoracic Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Seyoum Kassa
- Cardiothoracic Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Ethiopia
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14
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Najafi MJ, Davoodi M, Godazandeh GA, Zahmatkesh A, Faghani N, Bashiri R. Minimally invasive approach in symptomatic aberrant right subclavian artery treatment. Int J Surg Case Rep 2023; 108:108434. [PMID: 37418792 PMCID: PMC10382758 DOI: 10.1016/j.ijscr.2023.108434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Anomalous right subclavian artery (ARSA) represents an uncommon anatomical deviation concerning the genesis of the right subclavian artery. As the predominant embryological irregularity of the aortic arch, it is clinically recognized as arteria lusoria (AL). CASE PRESENTATION This study, describe the instance of a 22-year-old female exhibiting a non-aneurysmal, symptomatic anomalous right subclavian artery (ARSA) coursing posteriorly to the esophagus, as evidenced by thoracic computed tomography (CT) imaging. CLINICAL DISCUSSION As an attractive option, a minimally invasive surgical method was used to treat the patient, and the anomalous vessel was closed from the closest location to its origin in the aortic arch during a short time thoracoscopic surgery. DISCUSSION, CONCLUSION Compared to the common surgical methods to treat this anomaly, the complications and morbidity resulting from this method are much less and the length of stay in the hospital is shorter and the results are acceptable.
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Affiliation(s)
- M J Najafi
- Mazandaran Univ Med Sci, Dept Surg, Fac Med, Sari, Mazandaran Prov, Iran; Clinical Research Development Unit of Imam Khomeini Hospital, Mazandaran university of Medical Science, Sari, Iran
| | - M Davoodi
- Mazandaran Univ Med Sci, Dept Surg, Fac Med, Sari, Mazandaran Prov, Iran; Clinical Research Development Unit of Imam Khomeini Hospital, Mazandaran university of Medical Science, Sari, Iran.
| | - Gh A Godazandeh
- Mazandaran Univ Med Sci, Dept Surg, Fac Med, Sari, Mazandaran Prov, Iran
| | - A Zahmatkesh
- Mazandaran Univ Med Sci, Dept Surg, Fac Med, Sari, Mazandaran Prov, Iran
| | - N Faghani
- Mazandaran Univ Med Sci, Dept Surg, Fac Med, Sari, Mazandaran Prov, Iran
| | - R Bashiri
- Mazandaran Univ Med Sci, Dept Surg, Fac Med, Sari, Mazandaran Prov, Iran
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15
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Prevalence and Complications of Aberrant Subclavian Artery in Patients With Heritable and Nonheritable Arteriopathies. J Am Coll Cardiol 2023; 81:979-991. [PMID: 36889877 DOI: 10.1016/j.jacc.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND An aberrant subclavian artery (ASA) (or lusoria) is the most common congenital anomaly of the aortic arch (0.5%-2.2%; female-to-male ratio 2:1 to 3:1). ASA can become aneurysmal and result in dissection, involving Kommerell's diverticulum when present and the aorta. Data of its significance in genetic arteriopathies are not available. OBJECTIVES The purpose of this study was to assess the prevalence and complications of ASA in gene-positive and -negative nonatherosclerotic arteriopathies. MATERIALS The series includes 1,418 consecutive patients with gene-positive (n = 854) and gene-negative arteriopathies (n = 564) diagnosed as part of institutional work-up for nonatherosclerotic syndromic and nonsyndromic arteriopathies. Comprehensive evaluation includes genetic counseling, next-generation sequencing multigene testing, cardiovascular and multidisciplinary assessment, and whole-body computed tomography angiography. RESULTS ASA was found in 34 of 1,418 cases (2.4%), with a similar prevalence in gene-positive (n = 21 of 854, 2.5%) and gene-negative (n = 13 of 564, 2.3%) arteriopathies. Of the former 21 patients, 14 had Marfan syndrome, 5 had Loeys-Dietz syndrome, 1 had type-IV Ehlers-Danlos syndrome, and 1 had periventricular heterotopia type 1. ASA did not segregate with genetic defects. Dissection occurred in 5 of 21 patients with genetic arteriopathies (23.8%; 2 Marfan syndrome and 3 Loeys-Dietz syndrome), all with associated Kommerell's diverticulum. No dissections occurred in gene-negative patients. At baseline, none of the 5 patients with ASA dissection fulfilled criteria for elective repair according to guidelines. CONCLUSIONS The risk of complications of ASA is higher in patients with genetic arteriopathies and is difficult to predict. In these diseases, imaging of the supra-aortic trunks should enter baseline investigations. Determination of precise indications for repair can prevent unexpected acute events such as those described.
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16
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Nasser M, Petrocheli BB, Felippe TKS, Isola B, dos Santos Pereira BC, Sartoreli ALC, Batista JM, Brandão GMS. Aberrant right subclavian artery: case report and literature review. J Vasc Bras 2023; 22:e20210151. [PMID: 36855544 PMCID: PMC9968513 DOI: 10.1590/1677-5449.202101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/17/2022] [Indexed: 02/22/2023] Open
Abstract
The aberrant right subclavian artery, also known as the arteria lusoria, is the most common aortic arch anomaly, occurring in 0.5 to 1% of the population. There is a higher prevalence in women and it is usually associated with other anatomical variations, such as the non-recurrent laryngeal nerve, present in 86.7% of cases. In the majority of cases, the aberrant right subclavian artery causes no symptoms. We describe this anomaly in an 82-year-old, hypertensive, and asymptomatic patient who had undergone a thoracoabdominal angiography to investigate a chronic DeBakey type III aortic dissection with dilation of the descending aorta. The aberrant right subclavian artery followed a retroesophageal course and was associated with a Kommerell diverticulum. In view of its rarity, we conducted an integrative bibliographic review of literature from the last 6 years indexed on the Medline, UpToDate, Lilacs, Scielo, and Portal Capes databases and discuss the most frequent anatomical changes, symptomatology, and therapeutic management adopted.
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Affiliation(s)
- Michel Nasser
- Universidade Federal de São Carlos - UFSCar, Departamento de Medicina, São Carlos, SP, Brasil.
| | | | | | - Beatriz Isola
- Universidade Federal de São Carlos - UFSCar, Departamento de Medicina, São Carlos, SP, Brasil.
| | | | | | - João Marques Batista
- Universidade Federal de São Carlos - UFSCar, Departamento de Medicina, São Carlos, SP, Brasil.
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17
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Colpitts DK, Ragan MV, Spinosa DJ, Ryan L, Mukherjee D. Mid-Term Results of Treating Kommerell's Diverticulum and Aberrant Subclavian Artery Anomalies Using a Patient-Centered Team Approach. Vasc Endovascular Surg 2023:15385744231154082. [PMID: 36689395 DOI: 10.1177/15385744231154082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The management of Kommerell's Diverticulum (KD) has evolved from open surgical resection and graft replacement of the aorta, to endovascular repair in asymptomatic patients due to its recognized possible sequelae - aortic rupture and dissection. Despite these technical advances, standard indications for intervention and treatment algorithms remain unclear. We will present our single-center experience in the treatment of KD, supporting a multidisciplinary endovascular-first approach. METHODS All patients who underwent thoracic endovascular aortic repair (TEVAR) for KD between 2017 and 2020 were retrospectively identified from a prospectively maintained institutional surgery database. Chart review was used to characterize presenting symptoms, interventions, technical results, and complications. Revascularization was performed using carotid-axillary bypass. Routine endovascular subclavian artery occlusion was employed to eliminate retrograde diverticulum perfusion and avoid open ligation. RESULTS 8 patients were identified, including 6 females and 2 males between the ages of 44-76. Patients presented with dysphagia (n = 3), acute embolic stroke (n = 1), transient ischemic attack (TIA) (n = 1), upper extremity embolization (n = 1), and acute type B aortic dissection (n = 1). One patient had a prior incomplete open repair that was successfully treated endovascularly. Another patient had a mediastinal neoplasm infiltrating an incidental aberrant subclavian artery and KD. All cases had symptomatic improvement and successful endovascular repair as demonstrated on post-operative imaging. Perioperative complications included percutaneous access site pseudoaneurysm (n = 2), stroke (n = 1), and subclavian artery rupture immediately recognized and treated (n = 1). There was no perioperative mortality. CONCLUSION Endovascular techniques have resulted in technical success and symptomatic improvement for KD without open thoracotomy or sternotomy. Significant rates of endovascular complications and paucity of long-term durability data should be considered. Until formal criteria for repair are established, early application of TEVAR using a consistent multi-specialty approach may mitigate the risk of unpredictable aortic complications in these patients while avoiding the accepted morbidity and mortality of open surgery.
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Affiliation(s)
- Dayle K Colpitts
- Department of Surgery, General Surgery, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Mecklin V Ragan
- Department of Surgery, General Surgery, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - David J Spinosa
- Department of Radiology, Vascular and Interventional Radiology, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Liam Ryan
- Department of Surgery, Cardiac Surgery, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Dipankar Mukherjee
- Department of Surgery, Vascular Surgery, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
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18
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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; 47:382-389. [PMID: 36728158 DOI: 10.1097/rct.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to determine the prevalence and possible features associated with symptoms in adult patients diagnosed with an aberrant right subclavian artery (ARSA). METHODS In this single-center retrospective study, 386 adult patients were diagnosed with ARSA on chest CT scans performed between June 2016 and April 2021. Patients were grouped by the presence of symptoms, which included dysphagia, shortness of breath, cough, and upper airway wheezing. Four cardiothoracic radiologists reviewed the chest CT scans to assess features of ARSA. Agreement and multivariable logistic regression analyses were performed to determine interobserver variability and features associated with the presence of symptoms, respectively. RESULTS The prevalence of ARSA was 1.02% and 81.3% of patients were asymptomatic. Shortness of breath (74.6%) was the most common symptom. Interobserver agreement was acceptable with most variables having an interclass correlation coefficient or κ >0.80. A patient's height > 158 cm (OR: 2.50, P = 0.03), cross-sectional area > 60 mm2 of ARSA at the level of the esophagus (OR: 2.39, P = 0.046), and angle >108 degrees formed with the aortic arch (OR: 1.99, P = 0.03) were associated with the presence of symptoms on multivariable logistic regression. A distance increase per 1 mm between ARSA and trachea (OR: 0.85, P = 0.02) was associated with decreased odds of symptoms. CONCLUSIONS Aberrant right subclavian artery is an incidental finding in most adult patients. The cross-sectional area at the level of the esophagus, angle formed with the medial wall of the aortic arch, distance between the ARSA and the trachea, and a patient's height were features associated with the presence of symptoms.
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19
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Nasser M, Petrocheli BB, Felippe TKS, Isola B, Pereira BCDS, Sartoreli ALC, Batista Junior JM, Brandão GMS. Artéria subclávia direita aberrante: relato de caso e revisão de literatura. J Vasc Bras 2023. [DOI: 10.1590/1677-5449.202101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Resumo A artéria subclávia direita aberrante, também conhecida como artéria lusória, é a anomalia do arco aórtico mais comum, ocorrendo entre 0,5 e 1% da população. Possui prevalência em mulheres e normalmente está associada a outras variações anatômicas, como o nervo laríngeo não recorrente, presente em 86,7% dos casos. Em sua maioria, a artéria subclávia direita aberrante não apresenta sintomas. Descrevemos essa alteração em uma paciente de 82 anos, hipertensa e assintomática, que havia sido submetida a uma angiotomografia toracoabdominal para a avaliação de uma dissecção crônica tipo III (DeBakey) associada à dilatação de aorta descendente. No achado, a artéria subclávia direita aberrante apresentava percurso retroesofágico associado a um divertículo de Kommerell. Devido à raridade, realizamos revisão bibliográfica integrativa das bases de dados MEDLINE, UpToDate, LILACS, SciELO e Portal CAPES dos últimos 6 anos e discutimos as alterações anatômicas mais frequentes, a sintomatologia e as condutas terapêuticas adotadas.
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20
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Evans WN, Acherman RJ, Restrepo H. Aortic Arch Laterality in Chromosome 22q11.2 Deletion Syndrome: Male-Female Difference. Clin Pediatr (Phila) 2022; 62:345-348. [PMID: 36214167 DOI: 10.1177/00099228221127730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We reviewed patients with chromosome 22q11.2 deletion syndrome. We analyzed cardiovascular findings in patients with confirmed chromosome 22q11.2 deletion syndrome live-born in Nevada between March 2007 and September 2020. We identified 60 patients. Of the 60 patients, 32 (53%) were female. Of the 60, 48 (80%) had a conotruncal abnormality (including isolated vascular rings): 23 of 32 (72%) for females versus 25 of 28 (89%) for males, P = .41. However, 11 (34%) of 32 females had a right aortic arch; whereas, 21 (75%) of 28 males had a right aortic arch, P = .007. In conclusion, in our patient cohort, we found conotruncal malformations were common. However, we noted males were statistically more likely to have a right aortic arch than females. To the best of our knowledge, this male-female aortic arch laterality difference in patients with chromosome 22q11.2 deletion syndrome has not been previously noted.
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Affiliation(s)
- William N Evans
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Humberto Restrepo
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
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21
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Venkatesan A, Gonuguntla A, Vasireddy A, Rai GD, Kamath GS, Bishnoi AK, Maramreddy R. Asymptomatic Giant Aneurysm of the Arteria Lusoria Treated by Debranching and Aneurysmal Resection. Vasc Specialist Int 2022; 38:3. [PMID: 35307697 PMCID: PMC8938156 DOI: 10.5758/vsi.210069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/01/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022] Open
Abstract
The aberrant right subclavian artery (ARSA, arteria lusoria) is the most common intrathoracic vascular anomaly, affecting up to 2% of the population. However, aneurysms of congenital anomalies are extremely unusual and often present with dysphagia, dysphonia, or dyspnea due to compression of the surrounding structures. We report a case of an asymptomatic 57-year-old male with chronic kidney disease who was incidentally found to have a large aneurysm of the ARSA on preoperative computed tomography for laparoscopic nephrectomy. Surgery is unequivocally warranted as these aneurysms are associated with a high risk of complications, including thrombosis, embolism, and rupture. We debranched the ARSA, followed by anastomosis to the right carotid artery through a right neck incision. Subsequently, aneurysmal resection was performed through left thoracotomy. The patient had an uneventful postoperative recovery and was asymptomatic during the follow-up.
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Affiliation(s)
- Aadithiyavikram Venkatesan
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Akhilesh Gonuguntla
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Anila Vasireddy
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Guruprasad D Rai
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Ganesh Sevagur Kamath
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Arvind Kumar Bishnoi
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Revanth Maramreddy
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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22
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Systematic review and meta-analysis of outcomes after operative treatment of aberrant subclavian artery pathologies and suggested reporting items. Eur J Vasc Endovasc Surg 2022; 63:759-767. [DOI: 10.1016/j.ejvs.2022.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 11/17/2022]
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23
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Upper Gastrointestinal Bleeding From Aberrant Right Subclavian Artery-Esophageal Fistula. Ochsner J 2022; 21:406-412. [PMID: 34984057 PMCID: PMC8675615 DOI: 10.31486/toj.20.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The most common aortic arch abnormality is an aberrant right subclavian artery (ARSA). ARSA-esophageal fistula is a rare sequela that can present with a life-threatening upper gastrointestinal (GI) bleed. Case Report: We report the case of an 88-year-old male who presented with signs of upper GI bleeding. Esophagogastroduodenoscopy demonstrated extrinsic compression of the upper third of the esophagus with ulceration. Imaging studies revealed ARSA posterior to the esophagus with pseudoaneurysm formation. These findings confirmed an upper GI bleed secondary to ARSA-esophageal fistula. The patient underwent prompt embolization of the ARSA pseudoaneurysm, followed a few days later by coil embolization of the ARSA pseudoaneurysm. Despite these interventions, the patient continued to have bleeding with anemia. He and his family opted to avoid any further interventions and instead pursued comfort care. The patient was discharged to hospice and died 3 months later. Conclusion: ARSA-esophageal fistula is a rare but potentially lethal cause of upper GI bleeding. Initial signs and symptoms can be subtle, but the presence of a GI bleed requires immediate stabilization. Surgical interventions have been shown to have longer-lasting success, but endovascular repair may be an option for patients who are deemed unfit for surgery but still require prompt stabilization. Regardless of the intervention, mortality rates for ARSA-esophageal fistula are high.
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Dong S, Alarhayem AQ, Meier G, Hardy DM, Lyden SP, Farivar BS. Contemporary management and natural history of aberrant right subclavian artery. J Vasc Surg 2021; 75:1343-1348.e2. [PMID: 34838611 DOI: 10.1016/j.jvs.2021.11.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE An aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch. A paucity of reported studies is available regarding the treatment of these patients. The purpose of the present study was to evaluate the contemporary management strategies and natural history of ARSA in these patients. METHODS A single-center retrospective review of patients with a diagnosis of ARSA from 2009 to 2019 was performed. Computed tomography scans were analyzed, and the aortic and ARSA diameters were measured at 10 different segments. The demographic data, comorbidities, and operative interventions were collected. The patients were categorized into those who had undergone intervention and those who had undergone expectant management. Linear mixed effect models were used to estimate the annual ARSA diameter changes. RESULTS A total of 30 patients with ARSA were identified, 17 (57%) of whom were women. The average age for the cohort was 54.5 ± 14.6 years. Of the 30 patients, 20 (67%) had undergone operative repair at presentation and 10 (33%) were initially observed. The most common presenting symptom was dysphagia (30%). Of the 10 patients who had been initially treated expectantly, 4 had subsequently required intervention. Of the 24 operative interventions, 13 (54%) were hybrid procedures involving right carotid-subclavian bypass or transposition and thoracic endovascular aortic repair. The mean diameter of ARSA at its origin was 20.4 ± 5.7 mm, and the mean cross-sectional aortic diameter at the level of the ARSA was 31.8 ± 8.5 mm for the entire cohort. For the patients who had initially been observed and had subsequently required intervention, the largest change in the ARSA cross-sectional diameter was observed 1 cm distally to the vessel ostium at a rate of 3.05 mm annually (95% confidence interval, 1.54-4.56; P < .001). No statistically significant changes in the annual growth rate of the aortic segments were observed in the entire cohort or for those patients who had undergone intervention (P > .05). CONCLUSIONS The decision to intervene on an ARSA should be individualized by the presence of symptoms (eg, dysphagia lusoria) or complications (eg, dissection, concomitant aortic aneurysmal disease, enlarging Kommerell diverticulum). Asymptomatic patients with nonaneurysmal ARSA might not require any intervention and can be safely observed. Measurement of the cross-sectional ARSA diameter 1 cm distally to the ostium of the vessel might aid in the surveillance of vessel diameter changes. Additional studies are required to determine the specific size criteria as an indication for operative repair of asymptomatic Kommerell diverticulum.
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Affiliation(s)
- Siwei Dong
- Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Abdul Q Alarhayem
- Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Garrett Meier
- Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - David M Hardy
- Cardiovascular Institute, South Georgia Medical Center, Valdosta, Ga
| | - Sean P Lyden
- Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Behzad S Farivar
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va.
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Bloom JP, Attia RQ, Sundt TM, Cameron DE, Hedgire SS, Bhatt AB, Isselbacher EM, Srivastava SD, Kwolek CJ, Eagleton MJ, Mohebali J, Jassar AS. Outcomes of open and endovascular repair of Kommerell diverticulum. Eur J Cardiothorac Surg 2021; 60:305-311. [PMID: 33582760 DOI: 10.1093/ejcts/ezab072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/20/2020] [Accepted: 01/13/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Kommerell diverticulum (KD) is a rare congenital vascular anomaly often associated with an aberrant subclavian artery (ASCA). Definitive indications for intervention remain unclear. We present open and endovascular (EV) operative outcomes in a large contemporary series and propose a management algorithm. METHODS Between 2004 and 2020, 224 patients presented with ASCA and associated KD to our institution. Of the 43 (19.2%) patients who underwent operative repair, 31 (72.1%) had open surgical (OS) repair via thoracotomy and 12 (27.9%) had EV repair. Univariable and bivariable statistical analyses were conducted stratified by approach. The median follow-up time was 5.4 years (IQR, 2.9-9.7). RESULTS Patients in EV group were older (68 years vs 47 years, P < 0.001) and had larger aneurysms (base diameter 3.2 cm vs 21.5 cm, P = 0.007). All patients with dysphagia lusoria were treated with open surgery (n = 20). Asymptomatic patients with incidentally detected KD (50% vs 16.1%), those with chest or back pain (50% vs 19.4%) and patients who presented with an aortic emergency (25% vs 6.5%) were more likely to be treated endovascularly (P = 0.001). Carotid-to-subclavian bypass was used in 38 (88.4%) patients. There were no operative mortalities. In-hospital mortality was similar between groups (3.2% vs 16.7%, P = 0.121). Mid-term mortality was higher in the EV group [4 (33.8%) vs 0, P < 0.001]. There were 2 (15.4%) postoperative strokes in the EV group. There were no statistically significant differences in other postoperative complications or hospital length of stay between groups. CONCLUSIONS KD can be managed using open or EV approaches with low morbidity and mortality. Treatment strategy should depend on clinical presentation and patient factors.
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Affiliation(s)
- Jordan P Bloom
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rizwan Q Attia
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandeep S Hedgire
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ami B Bhatt
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric M Isselbacher
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sunita D Srivastava
- Division of Vascular and Endovascular Surgery, Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Kwolek
- Division of Vascular and Endovascular Surgery, Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hale BW, Lu JC, Romano JC, Lowery R, Yu S, Norris MD. Kommerell diverticulum: distinctions between arch side, and evaluation of morphology, size, and risk. Ann Thorac Surg 2021; 114:848-856. [PMID: 34283954 DOI: 10.1016/j.athoracsur.2021.06.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/05/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Kommerell diverticulum (KD) is a dilated proximal aberrant subclavian artery associated with either right or left aortic arches (RAA-ARSA or LAA-ALSA). Although case series suggest KD may be a liability for vascular complications, the risk, pattern of dilation throughout the lifespan, and differences between arch sides, are not known. METHODS A single-center retrospective review of patients of all ages with KD on cross-sectional imaging. Maximal short axis diameter of KD (KDmax), absolute and indexed to descending aortic (DAo) diameter, was correlated with age. Comparisons were made between arch sides. Patients with vascular complications are described. RESULTS One hundred and four patients with KD were included [68 (65%) RAA-ALSA, 36 (35%) LAA-ARSA; 43 (41%) asymptomatic]. Although KDmax was correlated with age (RAA-ALSA r=0.84 [p<.0001]; LAA-ARSA r=0.51 [p=0.001]), KDmax/DAo was not (RAA-ALSA r=0.14 [p=0.27]; LAA-ARSA r=-0.22 [p=0.21]). RAA-ALSA had larger KDmax/DAo (1.02±0.20 vs 0.89±0.18 mm/mm, p=0.002), more symptoms (75% vs 28%, p <.0001), and younger age (median 9.5 vs 61.7 years, p<.0001). Six patients had vascular complications, age 58-80 years, all with LAA-ARSA and risk factors for acquired aneurysms. CONCLUSIONS In older patients, KDmax/DAo was not larger, arguing against isolated KD dilation with age. Diverticula from RAA-ALSA and LAA-ARSA demonstrate different phenotypes, suggesting different disease processes and likely different risk. The incidence of vascular complication was lower than previous reports, and occurred exclusively in patients with LAA-ARSA and aneurysm risk factors. This suggests conservative management of asymptomatic KD is often reasonable, especially with RAA-ALSA.
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Affiliation(s)
- Benjamin W Hale
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan; University of Michigan Adult Congenital Heart Disease Program, Ann Arbor, Michigan.
| | - Jimmy C Lu
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Jennifer C Romano
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Ray Lowery
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Sunkyung Yu
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Mark D Norris
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan; University of Michigan Adult Congenital Heart Disease Program, Ann Arbor, Michigan
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Dueppers P, Floros N, Schelzig H, Wagenhäuser M, Duran M. Contemporary Surgical Management of Aberrant Right Subclavian Arteries (Arteria Lusoria). Ann Vasc Surg 2020; 72:356-364. [PMID: 32949736 DOI: 10.1016/j.avsg.2020.08.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND An aberrant right subclavian artery (ARSA) is in most cases an asymptomatic aortic arch anomaly. However, dysphagia, aneurysm formation (ARSAA), associated Kommerell diverticulum, or cerebellar/arm malperfusion may require invasive therapy. Large-scale clinical trials do not exist in current literature. We report our patient's outcome of a single-center experience and delineate indications for treatment and surgical techniques. METHODS A single-center retrospective study was conducted between January 1, 2012 through March 1, 2018. Symptomatic or asymptomatic patients with ARSAA who received invasive treatment at the Department for Vascular and Endovascular Surgery, University Hospital Dusseldorf, Germany were included. RESULTS Eight patients (4 men, 63 ± 14 (39-78) years) were treated with single-stage (n = 4) or multistage (n = 4) procedures. Treatment for ARSAA (n = 4) included ARSA revascularization (subclavian-carotid transposition (SCT) = 3; carotid-subclavian bypass (CSB) = 1), aortic arch debranching (left SCT = 2, bilateral aorto-carotid bypass + left CSB = 1, right-to-left CSB + left-carotid-to-bypass transposition = 1), and thoracic endovascular aortic repair (TEVAR; n = 4). Other strategies included SCT for dysphagia (n = 2) or subclavian steal syndrome (n = 1) and balloon angioplasty for arm claudication (n = 1). Complications involved vascular access (n = 2) and each one partial common carotid artery overstenting without stroke during TEVAR and Horner syndrome after SCT. Mean follow-up was 23 ± 26 (9-67) months. After 7 months, 1 patient required vertebral artery coiling due to type II endoleak with ARSAA progression. Overall mortality was 0%. Technical and clinical success rates were 100%. CONCLUSIONS Surgical concepts for ARSA aim on preventing aneurysm rupture and alleviate dysphagia or ischemic symptoms. To generate satisfying patient outcomes, individualized therapy planning in specialized centers is vital.
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Affiliation(s)
- Philip Dueppers
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland; Department of Vascular and Endovascular Surgery, University Hospital of Dusseldorf, Duesseldorf, Germany.
| | - Nikolaos Floros
- Department of Vascular and Endovascular Surgery, University Hospital of Dusseldorf, Duesseldorf, Germany
| | - Hubert Schelzig
- Department of Vascular and Endovascular Surgery, University Hospital of Dusseldorf, Duesseldorf, Germany
| | - Markus Wagenhäuser
- Department of Vascular and Endovascular Surgery, University Hospital of Dusseldorf, Duesseldorf, Germany
| | - Mansur Duran
- Department of Surgery: Vascular and Endovascular Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
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Fernández Álvarez P, Valladolid León JM, Caunedo Álvarez Á. Esophageal compression by a mediastinal vascular structure as a result of a dysphagia lusoria. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:505. [PMID: 32379480 DOI: 10.17235/reed.2020.6592/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dysphagia lusoria is an uncommon cause of mechanical dysphagia due to extrinsic compression. It is a congenital aortic root abnormality that occurs as a consequence of an aberrant right subclavian artery, in most cases. We report an illustrative case of dysphagia lusoria in a young female, secondary to the presence of the abnormal mediastinal vessel.
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Co-Occurrence of Rarest Type of Dysphagia Lusoria (Type N-1) and Eosinophilic Esophagitis in a Cognitively Disabled Individual. Case Rep Med 2019; 2019:2890635. [PMID: 31814829 PMCID: PMC6877992 DOI: 10.1155/2019/2890635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 09/20/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022] Open
Abstract
Dysphagia is an expressive symptom, described by an individual as “difficulty in swallowing.” Dysphagia due to esophageal compression from an aberrant right subclavian artery is rare, and it is termed as “dysphagia lusoria.” We present a rare case of co-occurrence of dysphagia lusoria with esophageal eosinophilia in a patient with cognitive disability which portends a case with diagnostic challenge and treatment dilemma. A 31-year-old man with intellectual disability, cerebral palsy, previous history of feeding difficulty, and esophageal food impaction presented with esophageal foreign body impaction. He has no known history of atopy and food allergies. There was no laboratory evidence of peripheral eosinophilia. The IgE-mediated allergic test was unremarkable. His prior presentation revealed a diagnosis of eosinophilic esophagitis. The imaging studies showed proximal esophageal dilatation with extrinsic compression at the level of the upper esophagus. The foreign bodies were removed successfully through the help of upper endoscopy. Subsequent evaluation revealed a rare type of dysphagia lusoria (type N-1) due to an aberrant left subclavian artery arising from the right-sided aortic arch. The patient's family refused further management of artery lusoria. Prolonged stasis of secretions and food in the esophagus can also lead to increased esophageal eosinophils. In our case, it remains undetermined whether increased number of esophageal eosinophils resulted from primary eosinophilic esophagitis or due to prolonged food stasis from esophageal compression caused by an aberrant subclavian artery. However, food impaction right above the compression site makes dysphagia lusoria the likely etiology.
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Erben Y, Brownstein AJ, Velasquez CA, Li Y, Rizzo JA, Mojibian H, Tanweer M, Zafar MA, Ziganshin BA, Elefteriades JA. Natural history and management of Kommerell's diverticulum in a single tertiary referral center. J Vasc Surg 2019; 71:2004-2011. [PMID: 31708305 DOI: 10.1016/j.jvs.2019.08.260] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/18/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The Kommerell diverticulum (KD) is an extremely rare developmental abnormality of the aorta related to an aberrant subclavian artery (ASCA). The objective of our study was to review the natural history of KD and ASCA using our single-center experience in diagnosing and managing KD and ASCA. METHODS A retrospective review of the Yale radiological database from January 1999 to December 2016 was performed. Only patients with KD/ASCA and a computed tomography (CT) scan of the chest were selected for review. The primary goal was to examine the natural history of KD and ASCA and the secondary goals were to review the management and outcomes of those patients treated for KD and ASCA. RESULTS There were 75 patients with KD/ASCA identified, with a mean age of 63 ± 19 years; 49 were female (65%). On CT scans, left- and right-sided aortas were present in 47 (63%) and 28 (37%) patients. A right ASCA or a left ASCA were present in 47 (63%) and 28 (37%) patients. Six patients were symptomatic on presentation. Symptoms included dysphagia, chest or back pain, and emboli to the fingers. The mean KD diameter was 21.8 ± 6.0 mm and the distance to the opposite aortic wall (DAW) was 48.3 ± 10.8 mm. Sixty-six patients were followed for a mean of 31.7 ± 32.5 months. One patient ruptured without repair. Nine patients underwent operative intervention, including eight open and one endovascular repair. Complications from operative intervention included ischemic stroke with hemorrhagic transformation, deep vein thrombosis and pneumonia. The mean growth rate for KD and DAW was 1.45 ± 0.39 mm/year and 2.29 ± 0.47 mm/year, respectively. On multivariable regression analysis, hypertension was a predictor of growth of DAW (P = .03). CONCLUSIONS KD is uncommon and shows a female predominance. The diverticulum grows, albeit slowly (KD and DAW growth rates of 1.45 ± 0.39 mm/year and 2.29 ± 0.47 mm/year). Most patients are asymptomatic, but dysphagia, chest/back pain, and distal emboli may occur. Rupture is rare. Symptomatic patients should be operated. Asymptomatic patients can be followed with serial CT scans.
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Affiliation(s)
- Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - Adam J Brownstein
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Camilo A Velasquez
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, NJ
| | - John A Rizzo
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Hamid Mojibian
- Section of Vascular Interventional Radiology, Yale School of Medicine, New Haven, Conn
| | - Maryam Tanweer
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Conn
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Conn.
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Epperson MV, Howell R. Dysphagia lusoria: problem or incidentaloma? Curr Opin Otolaryngol Head Neck Surg 2019; 27:448-452. [PMID: 31633492 DOI: 10.1097/moo.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To address the incidental versus pathogenic nature of dysphagia lusoria and to provide a review of the cause, clinical presentation, diagnosis, and treatment of this condition with respect to recent literature. RECENT FINDINGS Case reports comprise the majority of recent literature concerning dysphagia lusoria. Many patients with an aberrant right subclavian artery (ARSA) have additional coexisting vascular anomalies. While most individuals present around age 50, some present as children and neonates. Of note, this population may present with dysphagia as opposed to respiratory findings alone, as previously described. In the diagnostic workup, most patients receive a battery of radiologic tests, which may not be necessary. Significantly, dietary modifications and medical management alone may resolve symptoms. Nonetheless, a wide range of operative techniques are available for the treatment of dysphagia lusoria. SUMMARY Clinicians should have a higher suspicion for dysphagia lusoria in patients with known vascular, heart, or chromosomal anomalies. Diagnosis should begin with a barium esophagram followed by a computed tomography angiogram or magnetic resonance angiogram. Avoid unnecessary studies. In many cases, an ARSA may be an incidental finding with comorbid gastroesophageal reflux disease or another medical condition responsible for the symptoms. Medical versus surgical management should be considered on a case-by-case basis.
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Affiliation(s)
| | - Rebecca Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Riangwiwat T, Limpruttidham N, Mumtaz T, Blankenship JC. Coronary Angiography in Patients with Arteria Lusoria via Right Radial Access: A Case Series and Literature Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:417-421. [PMID: 31257174 DOI: 10.1016/j.carrev.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/13/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
Transradial is becoming the access of choice for coronary angiography (CAG). Arteria lusoria (AL) poses a challenge for right transradial access because it can cause difficulty in accessing the ascending aorta. Of 18,686 patients who underwent CAG in Geisinger Medical Center from 2012 to 2018, 6 had a diagnosis of AL. Four underwent attempted right radial access, in 3 cases before AL was identified. All were successful, and one patient had successful right transradial percutaneous coronary intervention. CAG and PCI can be successfully performed using right radial access in patients with AL.
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Affiliation(s)
- Tanawan Riangwiwat
- Cardiology Department, Geisinger Medical Center, Danville, PA, United States of America.
| | - Nath Limpruttidham
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, United States of America
| | - Tayebah Mumtaz
- Internal Medicine Department, Geisinger Medical Center, Danville, PA, United States of America
| | - James C Blankenship
- Cardiology Department, Geisinger Medical Center, Danville, PA, United States of America
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Tawfik AM, Sobh DM, Ashamallah GA, Batouty NM. Prevalence and Types of Aortic Arch Variants and Anomalies in Congenital Heart Diseases. Acad Radiol 2019; 26:930-936. [PMID: 30266547 DOI: 10.1016/j.acra.2018.08.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Aortic arch (AA) variants and anomalies are important to recognize in patients with congenital heart disease (CHD) before surgery or intervention. The aim was to study the prevalence of AA anomalies and variants in patients with CHD compared to a control group. The secondary outcome was to report the associations between common variations of AA and specific types of CHD. MATERIALS AND METHODS After institutional review board approval, computed tomography studies of 352 CHD patients and control group of 400 consecutive computed tomography scans of the thorax were evaluated. The AA was assigned to one of seven common types, and their distribution was compared between CHD and control. The distribution of the AA anomalies and variants was evaluated as regard specific types of CHD and the visceroatrial situs. RESULTS Normal three-vessel branching pattern was the commonest in both groups, but was present in only 50.5% in the CHD compared to 68.5% in the control group, p < 0.00001. Right AA and aberrant right subclavian artery were significantly more common in CHD than control group (18.1% versus 0.25%, p < 0.00001) and (4.5% versus 0.25%, p = 0.0001), respectively. Direct aortic origin of left vertebral artery was insignificantly more common in CHD group (4.2% versus 2.7%, p = 0.258). Brachiobicephalic trunk was significantly more common in control than CHD group (27.7% versus 19.3%, p = 0.007). CONCLUSION Normal three-vessel AA was significantly less common in CHD. AA anomalies (right arch and aberrant right subclavian) were more common in CHD than control, while AA variants (brachiobicephalic trunk and direct aortic origin of left vertebral artery) were not.
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Affiliation(s)
- Ahmed M Tawfik
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Donia M Sobh
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Germeen A Ashamallah
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Nihal M Batouty
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
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Outcomes of Repair of Kommerell Diverticulum. Ann Thorac Surg 2019; 108:1745-1750. [PMID: 31254511 DOI: 10.1016/j.athoracsur.2019.04.122] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/04/2019] [Accepted: 04/29/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Kommerell diverticulum (KD) is an uncommon congenital vascular anomaly. This study assessed outcomes of open and endovascular repair of this disorder. METHODS Between 1997 and 2016, 152 adult patients presented with KD at Cleveland Clinic (Cleveland, OH), 87 had no intervention, and 65 underwent open repair (n = 55; 19 elephant trunk [ET] procedures [9 with aortic dissection], including 7 frozen ET, and completions with 5 thoracic endovascular aortic repairs, 2 open, and 5 lost to follow-up) or endovascular procedures (n = 10). Non-ET open KD repairs consisted of resection (n = 15), interposition graft (n = 16), patch (n = 4), or aortopexy (n = 1). Maximum KD diameter was 2.1 cm for nonsurgical patients and 3.2 cm for surgical patients. Among surgical patients, 51 of 65 had dysphagia or dyspnea. A total of 608 patient-years of follow-up were available. RESULTS For patients who underwent open and endovascular procedures, after multivariable adjustment, symptoms of dysphagia and hypertension predicted the likelihood of surgery (P < .05, all). There was no operative mortality. Complications included nondisabling stroke (n = 5; 8%), tracheostomy (n = 3; 4.6%), vocal cord paralysis (n = 2; 3%), and reoperation for bleeding (n = 3; 4.6%). During follow-up, 3 of 10 patients treated with hybrid or endovascular procedures required reinterventions for endoleaks. One patient had residual symptoms after aortopexy. Among nonsurgical patients, 2 patients refused surgery, and 1 died of aortic rupture, with a 4.7-cm descending aorta and a 3.4-cm KD. Seven additional patients died of nonaortic comorbidities. The remaining patients were asymptomatic, with an aortic diameter smaller than 4.5 cm. CONCLUSIONS Open and endovascular approaches have a high success rate and low mortality risk. Selection of the specific type of intervention should be based on patient anatomy, additional needed procedures, and comorbid conditions.
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Ikeno Y, Koda Y, Yokawa K, Gotake Y, Henmi S, Nakai H, Matsueda T, Inoue T, Tanaka H, Okita Y. Graft Replacement of Kommerell Diverticulum and In Situ Aberrant Subclavian Artery Reconstruction. Ann Thorac Surg 2019; 107:770-779. [DOI: 10.1016/j.athoracsur.2018.07.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 06/15/2018] [Accepted: 07/09/2018] [Indexed: 11/26/2022]
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Abstract
UNLABELLED PurposeThe aim of the study was to perform CT angiography-based evaluation of aberrant right subclavian artery prevalence, anatomy, and its influence on clinical symptoms. METHODS A total of 6833 patients who underwent 64-slice or dual-source CT angiography and those who revealed aberrant right subclavian artery underwent evaluation of its anatomy and were interviewed for the presence of clinical symptoms. RESULTS Aberrant right subclavian artery was found in 32 (0.47%) patients consisting of 13 males and 19 females, with mean age of 60.8±13.4 years. Among the interviewed 30 (94%) patients, oesophageal compression was observed in 14 cases (47%) and tracheal compression in three cases (10%). None of the patients underwent surgery related to aberrant right subclavian artery. Dysphagia was the most common clinical symptom in nine cases (30%), and in those patients the median distance between aberrant right subclavian artery and trachea was lower (4 mm) than in individuals without dysphagia (7.5 mm) (p = 0.009). The median lumen area of the aberrant right subclavian artery at the level of oesophagus was higher in patients with dysphagia (208 mm2) compared with individuals without dysphagia (108 mm2) (p = 0.01). CONCLUSIONS Aberrant right subclavian artery is a rare occurring abnormality in CT angiography. In the evaluated adult population, the most common symptom was dysphagia, which occurred in patients with decreased distance between aberrant right subclavian artery and trachea and increased lumen area of the aberrant artery at the level of compressed oesophagus.
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Abstract
BACKGROUND Aberrant right subclavian artery is the most common congenital aortic arch anomaly. There are a few reports concerning the clinical manifestations and follow-up of this CHD detected by echocardiographic screening. METHODS A total of 1737 full-term neonates, with a male-to-female ratio of 900:837, received echocardiographic screening. Neonates with or without isolated aberrant right subclavian artery were studied during infancy. RESULTS Among the 1737 cases, a total of 15 (0.86%) female-predominant neonates, with a male-to-female ratio of 6:9, had isolated aberrant right subclavian artery. They were compared with 20 age- and gender-matched normal neonates. There were no significant differences in maternal age, gestational age, or para gravity between the two groups, except for birth size (birth length- and weight-for-age percentiles, p = 0.006 and 0.045, respectively), which was smaller in the aberrant right subclavian artery group. Although there were no significant differences in developmental history, gastrointestinal, or respiratory symptoms, neonates with aberrant right subclavian artery had a higher incidence of mild developmental delay and feeding difficulty than normal infants (21 versus 0%, p = 0.061; 36 versus 20%, p = 0.264, respectively). The growth rates of body length and weight during infancy were not significantly different between the two groups. CONCLUSIONS Echocardiography can be applied as a first-line investigation in the diagnostic work-up for aberrant right subclavian artery. Neonates with aberrant right subclavian artery had a smaller size at birth, although growth rates were not significantly different from those of normal infants. This study does not support an active surgical policy for asymptomatic infants with isolated aberrant right subclavian artery. A larger study and longer follow-up of affected infants is recommended.
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Soo Hoo AJ, Rokkas CK, Rossi PJ. Migration of endovascular plug in hybrid repair of dysphagia lusoria. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:140-143. [PMID: 29942904 PMCID: PMC6013000 DOI: 10.1016/j.jvscit.2018.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/11/2018] [Indexed: 12/31/2022]
Abstract
Aberrant right subclavian artery is the most common brachiocephalic artery congenital abnormality and may result in dysphagia from external compression by the aberrant artery on the esophagus. Repair of this anatomic variant can be performed by both open and hybrid endovascular techniques. This case illustrates a complication of a hybrid repair resulting in proximal migration of a vascular occlusion plug, presenting as recurrent dysphagia and need for open surgical extraction of the plug.
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Affiliation(s)
- Andrew J Soo Hoo
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, Wisc
| | - Chris K Rokkas
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisc
| | - Peter J Rossi
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, Wisc
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Still GG, Li S, Wilson M, Wong L, Sammut P. Retrotracheal Aberrant Right Subclavian Artery: Congenital Anomaly or Postsurgical Complication? Glob Pediatr Health 2018; 5:2333794X18762689. [PMID: 29552601 PMCID: PMC5846904 DOI: 10.1177/2333794x18762689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/05/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
| | - Shuo Li
- Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Mark Wilson
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Lincoln Wong
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul Sammut
- University of Nebraska Medical Center, Omaha, NE, USA
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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; 30:1024-1028. [DOI: 10.1002/ca.22905] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Anthony P. Polednak
- Retired, Connecticut Tumor Registry, Connecticut Department of Public Health; Hartford Connecticut
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Padmanabhan A, Thomas AV, Sandeep GSK. Aberrant right subclavian artery syndrome manifesting as focal tracheomalacia. Lung India 2017; 34:292-294. [PMID: 28474661 PMCID: PMC5427763 DOI: 10.4103/0970-2113.205328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tracheomalacia is one of the rarest etiologies of chronic cough. Herein, we present the case of an elderly woman with chronic cough who on detailed evaluation was found to have focal (localized) tracheomalacia due to compression by an aberrant right subclavian artery (arteria lusoria). The absence of dysphagia in this patient also deserves particular mention.
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Affiliation(s)
- Arjun Padmanabhan
- Department of Respiratory Medicine, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - Abin Varghese Thomas
- Department of Respiratory Medicine, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - G S K Sandeep
- Department of Radiodiagnosis, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
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Mayer J, van der Werf-Grohmann N, Kroll J, Spiekerkoetter U, Stiller B, Grohmann J. Dysphagia after arteria lusoria dextra surgery: Anatomical considerations before redo-surgery. World J Cardiol 2017; 9:191-195. [PMID: 28289534 PMCID: PMC5329747 DOI: 10.4330/wjc.v9.i2.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/28/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Aberrant right subclavian artery (arteria lusoria) is the most common congenital root anomaly, remaining asymptomatic in most cases. Nevertheless, some of the 20%-40% of those affected present tracheo-esophageal symptoms. We report on a 6-year-old previously healthy girl presenting with progressive dysphagia over 4 wk. Diagnostics including barium swallow, echocardiography and magnetic resonance angiography (MRA) revealed a retro-esophageal compression by an aberrant right subclavian artery. Despite the successful, uneventful transposition of this arteria lusoria to the right common carotid via right-sided thoracotomy, the girl was suffering from persisting dysphagia. Another barium swallow showed the persistent compression of the esophagus on the level where the arteria lusoria had originated. As MRA showed no evidence of a significant re-obstruction by the transected vascular stump, we suspected a persisting ligamentum arteriosum. After a second surgical intervention via left-sided thoracotomy consisting of transecting the obviously persisting ligamentum and shortening the remaining arterial stump of the aberrant right subclavian artery, the patient recovered fully. In this case report we discuss the potential relevance of a persisting ligamentum arteriosum for patients with left aortic arch suffering from dysphagia lusoria and rational means of diagnosing, as well as the surgical options to prevent re-do surgery.
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The aberrant right subclavian artery: cadaveric study and literature review. Surg Radiol Anat 2016; 39:559-565. [DOI: 10.1007/s00276-016-1796-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/05/2016] [Indexed: 12/12/2022]
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Significance of Fetal Aberrant Right Subclavian Artery and Comparison with Other Second Trimester Markers for Down Syndrome Screening. JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-016-0104-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
An aberrant right subclavian artery arising from a left aortic arch is the most frequently described congenital aortic arch anomaly, occurring in 0.5 to 2.3% of the general population. Despite the retro-oesophageal course of the aberrant subclavian artery, an arterio-oesophageal fistula is an uncommon finding, only previously reported as a very rare complication in critically ill patients with oesophageal instrumentation or foreign body ingestion. We describe a unique case of a spontaneous aberrant right subclavian arterio-oesophageal fistula without an inciting event in a 17-month-child.
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Scala C, Leone Roberti Maggiore U, Candiani M, Venturini PL, Ferrero S, Greco T, Cavoretto P. Aberrant right subclavian artery in fetuses with Down syndrome: a systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:266-276. [PMID: 25586729 DOI: 10.1002/uog.14774] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 11/09/2014] [Accepted: 12/23/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The primary objective was to estimate the prevalence of aberrant right subclavian artery (ARSA) in fetuses with Down syndrome. Secondary objectives were to assess the prevalence of ARSA in euploid fetuses, the feasibility of ultrasound evaluation of the right subclavian artery (RSA) in the first and second trimesters of pregnancy, the performance of ARSA in screening for trisomy 21 and its association with other abnormalities. METHODS Web-based databases (PubMed, EMBASE and MEDLINE) were searched up to July 2014. The STROBE, PRISMA and QUIPS instruments were used to assess all included studies and for reporting of methodology, results and conclusions. Original studies that reported prenatal ultrasound evaluation of ARSA, assessment of its prevalence in Down-syndrome and euploid fetuses, feasibility of ultrasound evaluation of the RSA in the first and second trimesters of pregnancy and correlation of ARSA with other abnormalities were included, excluding duplications and case reports. Collected data were summarized to estimate prevalence and feasibility. A meta-analysis was performed pooling the study-specific positive and negative likelihood ratios (LR+ and LR-), detection rates and false-positive rates for trisomy 21. RESULTS Prevalence of ARSA in Down-syndrome fetuses was 23.6% (95% CI, 19.4-27.9%), whereas in euploid fetuses it was 1.02% (95% CI, 0.86-1.10%). Ultrasound evaluation of the RSA course and origin in the first and second trimesters of pregnancy was feasible in 85% and 98% of cases (first and second trimester, respectively) and it was directly related to sonographic experience and fetal crown-rump length and inversely related to maternal body mass index. In more than 20% of fetuses with ARSA there was an association with other abnormalities but ARSA seemed to be an independent marker of trisomy 21. The meta-analysis showed that ARSA is a significant risk factor for Down syndrome (pooled LR+ = 26.93, 95% CI, 19.36-37.47, P for effect < 0.001, P for Q = 0.3, I(2) = 17.3%), whereas normal RSA is a significant protective marker (pooled LR- = 0.71, 95% CI, 0.51-0.99, P for effect = 0.043, P for Q = 0.9, I(2) = 0%). CONCLUSIONS ARSA appears to be a clinically useful prenatal ultrasound marker of Down syndrome. Additional testing when ARSA is diagnosed should involve evaluation of all risk factors by applying a mathematical model. There is insufficient evidence to recommend fetal karyotyping in cases with isolated ARSA. If the background risk is higher or additional markers are present, full fetal karyotyping is advisable, including analysis for 22q11 microdeletion.
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Affiliation(s)
- C Scala
- Department of Obstetrics and Gynecology, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy
| | - U Leone Roberti Maggiore
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - M Candiani
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - P L Venturini
- Department of Obstetrics and Gynecology, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy
| | - S Ferrero
- Department of Obstetrics and Gynecology, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy
| | - T Greco
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Cavoretto
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
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Zingarelli A, Morelli MC, Seitun S, Bezante GP, Balbi M, Brunelli C. Aberrant right subclavian artery (arteria lusoria) challenging 4-French homolateral transradial coronary catheterisation in adulthood. Heart Lung Circ 2015; 24:e164-8. [PMID: 26092751 DOI: 10.1016/j.hlc.2015.04.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 03/31/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
We report a case of an accidental finding of an aberrant right subclavian artery diagnosed in an adult man during a 4-French coronary angiography performed by right transradial access, then confirmed by multi-slice computed tomography. Tips and tricks have been suggested to complete the 4-French procedure avoiding changing the vascular access.
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Affiliation(s)
| | - Margherita Castiglione Morelli
- Radiology and Interventional Radiology, San Martino University Hospital and Scientific Institute for Cancer Research, Genoa, Italy
| | - Sara Seitun
- Radiology and Interventional Radiology, San Martino University Hospital and Scientific Institute for Cancer Research, Genoa, Italy
| | | | - Manrico Balbi
- Interventional Cardiology, University of Genoa, Genoa, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
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Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg 2015; 63:245-59. [PMID: 25636900 DOI: 10.1007/s11748-015-0521-3] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Indexed: 11/30/2022]
Abstract
Kommerell's diverticulum is a developmental error with a remnant of fourth dorsal aortic arch, named after Dr. Kommerell, a radiologist, who made the first diagnosis in a living individual. The diverticulum can occur in both the left and right aortic arch, from which an aberrant subclavian artery rises to the contralateral side. Pediatric patients often present with airway symptoms whereas dysphagia and chest discomfort are more common in the adult patients. Computed tomography or magnetic resonance imaging can provide details of the diverticulum, associated arch anomalies, and its relationship with surrounding organs. Recent histological studies indicated the presence of cystic medial necrosis in the diverticulum wall, which would explain the reported high rates of aortic dissection and rupture associated with the diverticulum. Accumulated knowledge on this entity and the recent advancement of imaging techniques, surgical/endovascular strategies, and perioperative management, have led to more aggressive intervention to the diverticulum in the early phase. While still under debate it is generally accepted to consider surgical intervention when the diameter of the diverticulum orifice exceeds over 30 mm, and/or the diameter of the descending aorta adjacent to the diverticulum exceeds over 50 mm. Treatment options include open surgical repair, hybrid endovascular repair, and total endovascular repair. The selection of treatment strategy for Kommerell's diverticulum should be based on the anatomy, comorbidities of the patient, and surgical expertise available. The summaries of open and endovascular repairs of over 210 cases from literature search from 2004 to 2014 are also provided in this review.
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Affiliation(s)
- Akiko Tanaka
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago, 5841 Maryland Avenue, Suite E-500/MC5040, Chicago, IL, 60637, USA
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Polguj M, Chrzanowski Ł, Kasprzak JD, Stefańczyk L, Topol M, Majos A. 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. ScientificWorldJournal 2014; 2014:292734. [PMID: 25105156 PMCID: PMC4102086 DOI: 10.1155/2014/292734] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/22/2014] [Accepted: 05/06/2014] [Indexed: 12/20/2022] Open
Abstract
The most important abnormality of the aortic arch is arguably the presence of an aberrant right subclavian artery (arteria lusoria). If this vessel compresses the adjacent structures, several symptoms may be produced. The aim of the study is to present the morphological and clinical aspects of the aberrant right subclavian artery. Three different databases searched for a review of pertinent literature using strictly predetermined criteria. Of 141 cases, 15 were cadaveric and 126 were clinically documented. The gender distribution of the subjects was 55.3% female and 44.7% male. The mean age of the patients at symptoms onset was 49.9 ± 19.4 years for all patients but 54.0 ± 19.6 years and 44.9 ± 18.1 years for female and male subjects, respectively (P = 0.0061). The most common symptoms in this group were dysphagia (71.2%), dyspnea (18.7%), retrosternal pain (17.0%), cough (7.6%), and weight loss (5.9%). The vascular anomalies coexisting with an arteria lusoria were truncus bicaroticus (19.2%), Kommerell's diverticulum (14.9%), aneurysm of the artery itself (12.8%), and a right sided aortic arch (9.2%). In conclusion, compression of adjacent structures by an aberrant right subclavian artery needs to be differentiated from other conditions presenting dysphagia, dyspnea, retrosternal pain, cough, and weight loss.
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Affiliation(s)
- Michał Polguj
- Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
| | - Łukasz Chrzanowski
- Department of Cardiology, Medical University of Łódź, Kniaziewicza 33, 90-153 Łódź, Poland
| | - Jarosław D. Kasprzak
- Department of Cardiology, Medical University of Łódź, Kniaziewicza 33, 90-153 Łódź, Poland
| | - Ludomir Stefańczyk
- Department of Radiology, Medical University of Łódź, Kopcińskiego 22, 90-153 Łódź, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Łódź, Żeromskiego 113, 90-549 Łódź, Poland
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Hosn MA, Haddad F, El-Merhi F, Safadi B, Hallal A. Repair of an aberrant subclavian arterioesophageal fistula following esophageal stent placement. World J Gastrointest Surg 2014; 6:117-121. [PMID: 24976906 PMCID: PMC4073223 DOI: 10.4240/wjgs.v6.i6.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/02/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal complication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The patient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidisciplinary approach needed to diagnose and manage such a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possibility of such an anomaly in view of the growing popularity of esophageal stents, especially in the setting of a leak.
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