The aberrant right subclavian artery: cadaveric study and literature review

Abstract

Purpose: Taking into consideration that the aberrant right subclavian artery (ARSA) is the commonest congenital aortic arch anomaly (prevalence 0.16-4.4%), our goal was to investigate its incidence in Greeks, with respect to location, course, and relationship to trachea and esophagus. Gender dimorphism, coexisting neural, and vascular variations were also examined. The clinical impact and embryological background of the variation are discussed.

Methods: Two hundred and sixty-seven (126 male and 141 female) formalin-embalmed Greek cadavers (mean age 59 ± 13 years) were examined.

Results: The ARSA was detected in 6 cadavers (2.2%), 4 females (2.8%) and 2 males (1.6%). The artery followed a retroesophageal course in 83%, an interesophageotracheal course in 16.7%, while no pretracheal ARSA was detected. The ARSA coexisted with a bicarotid trunk, a Kommerell diverticulum, and a combination of them in one cadaver. Α combination of the ARSA with a thyroidea ima artery and a bilateral abnormal origin of the internal mammary artery was also detected in one case (17%), while no other associated anomaly was detected in a single case (17%). All ARSAs were accompanied with a right non-recurrent laryngeal nerve.

Conclusion: The ARSA has a relative high incidence in Greeks and a female predominance. The aberrant vessel follows a retroesophageal course in most cases and only one case with a location between trachea and esophagus was detected. The retroesophageal ARSA justifies the wide variety of clinical manifestations and complications occurred.

Keywords: Aberrant right subclavian artery; Aortic arch; Arteria lusoria; Bayford–Autenrieth dysphagia; Dysphagia; Variation.