Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions

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.

Figure 1.

Risk of bias assessment according to the JBI critical appraisal checklist. Each article was assessed using 8 questions by selecting answers “yes,” “unclear,” “no,” or “not applicable.” Articles were evaluated using the criteria: low risk of bias—>70% “yes” score, moderate risk of bias—50% to 69% “yes” score, and high risk of bias—<49% “yes” score. Two authors independently applied this tool to each case report to reach an overall appraisal judgment with supporting justifications for each article. JBI = Joanna Briggs Institute.

Figure 2.

Search flowchart. CINAHL = Cumulative Index to Nursing and Allied Health Literature, WOS = Web of Science.

Figure 3.

Types of origin of ARSA. Type I corresponds to an ARSA that arises as the last branch of the aortic arch, maintaining the origin of the other branches of this arch. Type II corresponds to an aberrant left subclavian artery associated with a bicarotid trunk, formed by both common carotid arteries. Type III is described as a mirror pattern of type I, with a right aortic arch from which arises a subclavian artery with a retroesophageal course that passes posterior to the 2 carotids and the right subclavian artery. ARSA = aberrant right subclavian artery.

Figure 4.

ARSA route types. (A) Retroesophageal course. (B) Course between the trachea and the esophagus. (C) Anterior course of the trachea. ARSA = aberrant right subclavian artery.

Figure 5.

Forest plot prevalence ARSA. ARSA = aberrant right subclavian artery.

Figure 6.

Risk of bias included studies. AQUA = Anatomical Quality Assurance.