Aberrant subclavian artery, or aberrant subclavian artery syndrome, is a rare anatomical variant of the origin of the right or left

subclavian artery In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery suppli ...

. This abnormality is the most common

congenital A birth defect is an abnormal condition that is present at childbirth, birth, regardless of its cause. Birth defects may result in disability, disabilities that may be physical disability, physical, intellectual disability, intellectual, or dev ...

vascular Vascular can refer to: * blood vessels, the vascular system in animals * vascular tissue Vascular tissue is a complex transporting tissue, formed of more than one cell type, found in vascular plants. The primary components of vascular tissue ...

anomaly of the

aortic arch The aortic arch, arch of the aorta, or transverse aortic arch () is the part of the aorta between the ascending and descending aorta. The arch travels backward, so that it ultimately runs to the left of the trachea. Structure The aorta begins ...

, occurring in approximately 1% of individuals.

Presentation

This condition is usually asymptomatic. The aberrant artery usually arises just distal to the left subclavian artery and crosses in the posterior part of the

mediastinum The mediastinum (from ;: mediastina) is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is a region that contains vital organs and structures within the thorax, mainly the heart and its vessels, the eso ...

on its way to the right

upper extremity The upper Limb (anatomy), limbs or upper extremities are the forelimbs of an upright posture, upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digit (anatomy), digits, including all the musc ...

. In 80% of individuals it crosses behind the

esophagus The esophagus (American English), oesophagus (British English), or œsophagus (Œ, archaic spelling) (American and British English spelling differences#ae and oe, see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), c ...

. Such course of this aberrant vessel may cause a vascular ring around the

trachea The trachea (: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from ...

and esophagus.

Dysphagia Dysphagia is difficulty in swallowing. Although classified under " symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or l ...

due to an aberrant right subclavian artery is termed

dysphagia lusoria Dysphagia lusoria (or Bayford-Autenrieth dysphagia) is an abnormal condition characterized by difficulty in swallowing caused by an aberrant right subclavian artery. It was discovered by David Bayford in 1761 and first reported in a paper by the sa ...

, although this is a rare complication. In addition to dysphagia, aberrant right subclavian artery may cause

stridor Stridor () is an extra-thoracic high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It is different from a stertor, which is a noise originating in the pharynx. Stridor is a physical sig ...

dyspnoea Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that c ...

chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...

, or

fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

. An aberrant right subclavian artery may compress the

recurrent laryngeal nerve The recurrent laryngeal nerve (RLN), also known as nervus recurrens, is a branch of the vagus nerve ( cranial nerve X) that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. There are two recur ...

causing a palsy of that nerve, which is termed

Ortner's syndrome Ortner's syndrome is a rare cardiovocal syndrome and refers to recurrent laryngeal nerve palsy from cardiovascular disease. It was first described by Norbert Ortner (1865–1935), an Austrian physician, in 1897. Dysphagia caused by a similar mech ...

. The aberrant right subclavian artery frequently arises from a dilated segment of the proximal descending aorta, the so-called Diverticulum of Kommerell (which was named for the German radiologist Burkhard Friedrich Kommerell (1901–1990), who discovered it in 1936). It is alternatively known as a lusorian artery.

Pathophysiology

In the normal embryological development of the

aortic arches The aortic arches or pharyngeal arch arteries (previously referred to as branchial arches in human embryos) are a series of six paired embryological vascular structures which give rise to the great arteries of the neck and head. They are ventral ...

, the right

dorsal aorta The dorsal aortae are paired (left and right) embryological vessels which progress to form the descending aorta. The paired dorsal aortae arise from aortic arches that in turn arise from the aortic sac. The primary dorsal aorta is located dee ...

regresses

caudal Caudal may refer to: Anatomy * Caudal (anatomical term) (from Latin ''cauda''; tail), used to describe how close something is to the trailing end of an organism * Caudal artery, the portion of the dorsal aorta of a vertebrate that passes into th ...

to the origin of the 7th

intersegmental artery The intersegmental arteries are a set of 30 arteries arising from the embryonic dorsal aorta, with each artery providing blood supply to one somite and its derivatives. Cervical intersegmental arteries The cervical intersegmental arteries merge i ...

which gives rise to the right

. In formation of an aberrant right subclavian artery, the regression occurs instead between the 7th intersegmental artery and the right

common carotid In anatomy, the left and right common carotid arteries (carotids) () are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries. Structure The common carotid a ...

so that the right subclavian artery is then connected to the left dorsal aorta via the part of the right dorsal aorta which normally regresses. During growth, the origin of the right subclavian artery migrates until it is just distal to that of the left subclavian.

Diagnosis

An aberrant subclavian artery (ASA) is commonly diagnosed through imaging studies that visualize the structure and origin of blood vessels. Is it often diagnosed incidentally. Here are the primary diagnostic tools used: Echocardiography: Especially in infants, an echocardiogram may initially detect abnormal vessel placement. Though this method can provide clues, it may not always offer detailed images of the aorta and subclavian arteries. Computed Tomography (CT) Angiography: CT scans with contrast provide high-resolution, 3D images of blood vessels, allowing clear visualization of the ASA’s location and course relative to the trachea and esophagus. Magnetic Resonance Imaging (MRI): MRI or MR angiography can similarly detail the vascular anatomy and is often used in children to reduce radiation exposure. Barium Swallow Study: If there are symptoms like dysphagia, this test can reveal if the esophagus is compressed by the aberrant artery, suggesting the presence of a vascular ring. Each of these techniques provides unique insights into the vascular structure, helping determine the presence, orientation, and potential impact of an aberrant subclavian artery.

Treatment

Surgery is occasionally used to treat the condition.

Images

File:Arteria lusoria Computertomographie.png, Aberrant subclavian artery at axial CT-scan. (1) trachea, (2) esophagus, (3) aberrant subclavian artery. File:Dysphagia lusoria.JPG, Aberrant right subclavian artery at angiography. File:Arteria lusoria Breischluck ap.png, Tape-like impression of the esophagus caused by aberrant subclavian artery. Below (arrows) narrowing of the esophagus by a tumor that is causing the swallowing problems. File:Arteria lusoria Breischluck.png, Aberrant subclavian artery seen at swallowing study: impression of the esophagus from behind.

References

External links

{{Congenital vascular defects Anatomical pathology Congenital vascular defects