Symptomatic Aberrant Right Subclavian Artery: Advantages of a Less Invasive Surgical Approach

Abstract

We present the case of a 33-year-old woman with a non-aneurysmal, symptomatic aberrant right subclavian artery (ARSA) traveling posterior to the esophagus, as demonstrated on chest computed tomography (CT) scans. She was treated with a less invasive surgical approach: closure of the anomalous vessel close to its origin from the aortic arch, through a left thoracoscopic procedure, followed by right common carotid-subclavian artery transposition via an open right supraclavicular approach. This method avoids the postoperative morbidity associated with open thoracic surgery and allows a clear identification of the anatomic structures minimizing possible procedure-related complications as a long residual arterial stump.

Keywords: arteria lusoria; dysphagia; less invasive surgical approach.

Fig. 1. Preoperative contrast-enhanced CT scan shows a non-aneurysmal arteria lusoria (red arrow) crossing upward and to the right behind a compressed and narrowed esophagus (red asterisk).

Fig. 2. Intraoperative view of video-assisted thoracoscopic surgery and open vascular surgery. (A) Isolation of the arteria lusoria close to the aortic arch with vessel loop (white arrow). (B) Mechanical stapling device for closure of the arteria lusoria. (C) End-to-side anastomosis (white arrow) between the divided aberrant right subclavian artery and the right common carotid artery. ARSA: aberrant right subclavian artery; RCCA: right common carotid artery

Fig. 3. Follow-up contrast-enhanced CT scan of the chest. (A) A coronal projection shows patent anastomosis of arteria lusoria to right common carotid artery (white arrow). (B) Remaining stump of the origin of arteria lusoria (red arrow).