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Aberrant Right Subclavian Artery

Right Subclavian Artery Anomalous Origin


Presentation

  • Eight cases (38%) presented with thoracic aortic aneurysm, two with intramural hematoma, and one with acute type B aortic dissection. Mean AARSA diameter was 4.2 cm; a single bicarotid common trunk was present in 38% of cases.[ncbi.nlm.nih.gov]
  • The presenting symptoms varied, and some patients had multiple symptoms noted on presentation, including dysphagia, dyspnea, or asymptomatic patients.[ncbi.nlm.nih.gov]
  • Occasionally, they present with symptoms related to oesophageal or tracheal compression.A 13-year-old girl presented with dysphagia and stridor was found to have an aberrant right subclavian artery.[ncbi.nlm.nih.gov]
  • We present a case of a patient repaired in this fashion.[ncbi.nlm.nih.gov]
  • This presentation is known as dysphagia lusoria. They are diagnosed by barium swallow or contrast-enhanced computed tomography, although it may be an incidental finding.[ncbi.nlm.nih.gov]
Mediastinal Lymphadenopathy
  • Lung cancer is seen involving the left inferior lobe (lung window not shown), with associated mediastinal lymphadenopathy. Accessorily, a small hiatal herniation is seen.[radiopaedia.org]
Lymphadenopathy
  • Lung cancer is seen involving the left inferior lobe (lung window not shown), with associated mediastinal lymphadenopathy. Accessorily, a small hiatal herniation is seen.[radiopaedia.org]
Sputum
  • Routine blood investigations were within normal limits, and sputum studies for mycobacterial as well as bacterial infections were negative. Chest X-ray posteroanterior view did not reveal any abnormality.[lungindia.com]
Vascular Disease
  • There was no past history of coronary or vascular disease. Physical examination revealed blood pressures 130/70 mmHg in the left arm and 100/60 mmHg in the right arm, with weak brachial, radial and ulnar pulses on the right side.[ijcasereportsandimages.com]
  • Multidetector computed tomography (MDCTA) is now an established diagnostic test in the evaluation of many vascular diseases [ 35 – 39 ].[intechopen.com]
Neck Pain
  • A 54-year-old man presented with neck pain, vertigo and loss of balance.[ncbi.nlm.nih.gov]
Encephalopathy
  • She had undergone tracheostomy due to hypoxic encephalopathy after cardiac surgery and suffered from dyspnea. Computed tomography revealed tracheal stenosis caused by a vascular ring made with an ARSA and the right common carotid artery.[ncbi.nlm.nih.gov]

Workup

Superior Mediastinal Mass
  • It is occasionaly responsible for causing dysphagia, dyspnoea, or acute ischaemia to the right upper limb, and it may present as a superior mediastinal mass in cases of aneurysm formation.[ncbi.nlm.nih.gov]
Karyotype Abnormal
  • Four other fetuses had unusual karyotype abnormalities. All fetuses with genetic anomalies had additional aberrant ultrasound findings. There were three spontaneous fetal deaths (trisomy 21-2 and Wolf-Hirshhorn-1).[ncbi.nlm.nih.gov]
Pleural Adhesions
  • Nevertheless, open repair of thoracoabdominal aortic aneurysms is still relevant in complex cases, including combined chronic aortic dissection, congenital aortic abnormalities such as aberrant right subclavian artery, and dense pleural adhesions after[ncbi.nlm.nih.gov]

Treatment

  • Surgical treatment was performed with aneurysmal exclusion and direct anastomosis of the two heads of the subclavian artery.[ncbi.nlm.nih.gov]
  • Abstract Aberrant right subclavian artery aneurysms are rare but carry a high risk of spontaneous rupture without any treatment. Aggressive early elective treatment is warranted.[ncbi.nlm.nih.gov]
  • The conventional surgical treatment of AL is the closure of the origin of AL and the revascularization of the right subclavian artery through a left thoracotomy.[ncbi.nlm.nih.gov]
  • An initial conservative treatment with delayed open repair was chosen. A review of the published literature with discussion of the case is presented.[ncbi.nlm.nih.gov]
  • OBJECTIVE: The objective of this multicenter registry was to review current treatments and late results of repair of aneurysm of aberrant right subclavian artery (AARSA).[ncbi.nlm.nih.gov]

Prognosis

  • A high index of suspicion is essential for early diagnosis and better prognosis.[ncbi.nlm.nih.gov]
  • Although scimitar syndrome and aberrant right subclavian artery are typically asymptomatic in adults, fistulous connection between the aberrant artery and the esophagus is associated with a poor prognosis.[ncbi.nlm.nih.gov]
  • Treatment and prognosis Given the rarity of this condition, there is no established management guideline.[radiopaedia.org]

Etiology

  • Discussion: We aimed to emphasize the possibility of aberrant right subclavian artery in who have recurrent or non-healing pneumonia without any etiology despite receiving long-term treatment.[scopemed.org]
  • ., Thiruvananthapuram - 695 029, Kerala India Source of Support: None, Conflict of Interest: None DOI: 10.4103/0970-2113.205328 Abstract Tracheomalacia is one of the rarest etiologies of chronic cough.[lungindia.com]
  • McKissock. (1934-35) The etiology of the vascular symptoms of cervical rib. Br. J. Surg. 22:406-414. Blalock, A. (1947) Technique of creation of an artificial ductus arteriosus in the treatment of pulmonary stenosis. J. Thoracic Surgery 16:244-254.[anatomyatlases.org]

Epidemiology

  • Literature on epidemiology, causes, and management options of acute aortic dissection in TS patients are reviewed and discussed.[ncbi.nlm.nih.gov]
  • Epidemiological and demographic characteristics The frequency of ARSA varies throughout the world.[intechopen.com]
Sex distribution
Age distribution

Prevention

  • To prevent any retrograde flow, an Amplatzer septal occluder was deployed at the distal subclavian artery.[ncbi.nlm.nih.gov]
  • Although the incidence of ARSA is very low, preoperative imaging and assessment of cerebral blood flow are critical to prevent a perioperative stroke.[ncbi.nlm.nih.gov]
  • It is important to report this finding during the evaluation of oncologic patients, to prevent severe complications that may arise from various oncologic interventions.[ncbi.nlm.nih.gov]
  • The presence of ARSA during esophagectomy may be challenging, but if diagnosed preoperatively, the precise and diligent dissection of the retroesophageal space during esophagectomy, may prevent any injury to the aberrant artery and consequent complications[ncbi.nlm.nih.gov]
  • Advantages include antegrade cerebral perfusion during arch repair, diminished extent of stenting due to the long elephant trunk, type II endoleak prevention by ARSA ligation and preservation of antegrade flow in the right vertebral artery.[ncbi.nlm.nih.gov]

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