Dysphagia lusoria caused by an aberrant right subclavian artery

Abstract

A 36-year-old, otherwise-healthy woman with a 6-year history of progressive dysphagia underwent an esophagogram that revealed an oblique extrinsic defect with an inferior-to-superior (left-to-right) course consistent with an aberrant right subclavian artery. An aortogram confirmed the diagnosis of aberrant right subclavian artery. She underwent surgical repair, tolerated the procedure well, and was discharged home, symptom free, on postoperative day 3. We found that the right supraclavicular approach provides good exposure and avoids the morbidity of the classically described approach via a median sternotomy or thoracotomy.

Fig. 1 Esophagogram: An oblique extrinsic defect courses from inferior (left) to superior (right) (arrow), consistent with an aberrant right subclavian artery at the upper thoracic level just above the aortic arch.

Fig. 2 Arteriogram: The aberrant right subclavian artery arises from the aorta distal to the origin of the left subclavian artery (arrow).

Fig. 3 Through a right supraclavicular incision (inset), the aberrant right subclavian artery was dissected and divided after application of vascular clamps. The proximal end was ligated and oversewn at the anomalous origin. The distal end was anastomosed to the right common carotid artery.

Fig. 4 A) The normal embryologic development of the aortic arches: Dotted lines represent normal vessel involution of the right dorsal aorta and the right 6th posterior arch. The persistence of the proximal right dorsal aorta becomes the innominate artery. B) Abnormal embryologic development of the aortic arch: The involution of the right 4th vascular arch and proximal right dorsal aorta leaves the right 7th intersegmental artery attached to the abnormally persistent right dorsal aorta. After rotation of the dorsal aorta, the right 7th intersegmental artery becomes the aberrant right subclavian artery.