REVIEW PAPER
Anatomical and clinical aspects of aberrant right subclavian artery
More details
Hide details
1
Department of Anatomy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
2
Cardiology Outpatient Clinic, Katowice, Poland
3
Department of Anatomy, Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
Submission date: 2023-04-26
Final revision date: 2023-05-25
Acceptance date: 2023-06-27
Publication date: 2023-09-30
Corresponding author
Tomasz Lepich
Tomasz Lepich
Department of Anatomy
Faculty of Medical Sciences
Medical University of Silesia
18 Medyków Street, 40-762 Katowice, Poland
Cardiology Outpatient Clinic
45 Graniczna Street, 40-018 Katowice, Poland
Medical Studies 2023;39(3):281-186
KEYWORDS
TOPICS
ABSTRACT
Atrophy of the fourth right aortic arch during embryogenesis can lead to arteria lusoria. This occurs with a frequency of 0.5–2%. This artery originates directly from the aortic arch as a fourth branch or from the proximal part of the descending aorta. Then it follows an upward and rightward direction crossing the trachea and esophagus in its course. This abnormal artery is accompanied in 20–60% of cases by dilatation of its proximal part, called Kommerell’s diverticulum. A correlation has been noted between the presence of arteria lusoria and chromosomal aberrations, mainly Down syndrome. Arteria lusoria in fetuses is diagnosed using ultrasound, and in adults, the gold diagnostic standard is computed tomography or magnetic resonance angiography. Consequences of arteria lusoria may include dysphagia (dysphagia lusoria), chronic cough, arterio-oesophageal fistula, retrosternal pain, respiratory problems, and numbness of the right upper limb. Respiratory disorders accompanying arteria lusoria occur mainly in children because their trachea is less rigid than in adults and more prone to deformation. Arteria lusoria is a clinically significant marker of fetal congenital malformations. It also may be a cause of non-specific symptoms in children and adults that should be considered during differential diagnosis.
REFERENCES (38)
1.
Elumala G, Mdletshe MB. Arteria Lusoria – aberrant right subclavian artery embryological basis and its clinical significance. Elixir Embryology 2016; 99: 43289-43292.
2.
Jeannon F. Arteria Lusoria: étude morphodensitométrique de 150 cas. Applications cliniques. Diss. UHP-Université Henri Poincaré, Nancy, France, 2011.
3.
Avisse C, Marcus C, Delattre JF, Marcus C, Cailliez-Toma- si JP, Palot JP, Ladam-Marcus V, Menanteau B, Flament JB. Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases. Surg Radiol Anat 1998; 20: 227-32.
4.
Cinà CS, Arena GO, Bruin G, Clase CM. Kommerell’s diverticulum and aneurysmal right-sided aortic arch: a case report and review of the literature. J Vasc Surg 2000; 32: 1208-1214.
5.
Loukas M, Giannikopoulos P, Fudalej M, Dimopoulos C, Wagner T. A retroesophageal right subclavian artery originating from the left aortic arch – a case report and review of the literature. Folia Morphol 2004; 63: 141-145.
6.
Molz G, Burri B. Aberrant subclavian artery (Arteria lusoria): sex differences in the prevalence of various forms of the malformation. Virchows Arch. A Path Anat and Histol 1978; 380: 303-315.
7.
van Son JA, Konstantinov IE. Burckhard F. Kommerell and Kommerell´s diverticulum. Tex Heart Inst J 2002; 29: 9-12.
8.
Fazan VPS, Ribeiro RA, Ribeiro JAS, Filho OAR. Right retroesophageal subclavian artery. Acta Cir Bras 2003; 18: 54-56.
9.
Myers PO, Fasel JHD, Kalangos A, Gailloud P. Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects. Ann Cardiol Angeiol 2010; 59: 147-154.
10.
Saito T, Tamatsukuri Y, Hitosugi T, Miyakawa K, Shimi- zu T, Oi Y, Yoshimoto M, Yamamoto Y, Spanel-Browski K, Steinke H. Three cases of retroesophageal right subclavian artery. J Nippon Med Sch 2005; 72: 375-82.
11.
Gorzelnik K, Bijok J, Kucińska-Chahwan A, Rudzińska M, Jóźwiak A, Bogdanowicz J, Jakiel G, Roszkowski T. Błądząca prawa tętnica podobojczykowa – nowy marker aberracji chromosomowych w badaniu USG drugiego trymestru: wstępne obserwacje na materiale własnym [Aberrant right subclavian artery (ARSA): a new sonographic marker for chromosomal aberrations in the second trimester: preliminary observations]. Ginekol Pol 2014; 85: 742-7.
12.
Fisher RG, Whigham CJ, Trinh C. Diverticula of Kommerell and aberrant subclavian arteries complicated by aneurysms. Cardiovasc Intervent Radiol 2005; 28: 553-560.
13.
Mossad E, Farid I, Youssef G, Ando M. Diverticulum of Kommerell: a review of a series and a report of a case with tracheal deviation compromising single lung ventilation. Anesth Analg 2002; 94: 1462-1464.
14.
Klinkhamer AC. Aberrant right subclavian artery: clinical and roentgenologic aspects. Am J Roentgenol 1966; 97: 438-446.
15.
Wang Z, Zhang H, Zhang P, He L, Dong W. Preoperative diagnosis and intraoperative protection of nonrecurrent laryngeal nerve: a review of 5 cases. Med Sci Monit 2014; 11: 233-237.
16.
Krupiński M, Irzyk M, Moczulski Z, Banyś R, Dwojak I, Urbańczyk-Zawadzka M. CT evaluation of aberrant right subclavian artery: anatomy and clinical implications. Cardiol Young 2019; 29: 128-132.
17.
Alghamdi MA, Al-Eitan LN, Elsy B, Abdalla AM, Mutwakil Mohammed H, Salih AGA, Al Hilal Al Ghamdi S. Aberrant right subclavian artery in a cadaver: a case report of an aortic arch anomaly. Folia Morphol 2021; 80: 726-729.
18.
Ostrowski P, Bonczar M, Przybycień W, Zamojska I, Kołodziejczyk B, Walocha J, Koziej M. An aberrant right subclavian artery in a 63-year-old male cadaver. Folia Morphol 2023; 82: 726-731.
19.
Ito T, Itoh A, Kiyoshima D, Ikeda Y. Anatomical characteristics of two cases of aberrant right subclavian artery. Anat Sci Int 2022; 97: 423-427.
20.
Kurt MA, An I, Ikiz T. Case with coincidence of aberrant right subclavianartery and common origin of the carotid arteries. Ann Anat 1997; 179: 175-176.
21.
Epstein DA, DeBor JR. Abnormalities associated with aberrant right subclavian arteries: a case report. Vasc Endovasc Surg 2002; 36: 297-303.
22.
Szpinda M. A new variant of aberrant left brachiocephalic trunk in man: case report and literature review. Folia Morphol 2005; 64: 47-50.
23.
Zapata H, Edwards JE, Titus JL. Aberrant right subclavian artery with left aortic arch: associated cardiac anomalies. Pediatr Cardiol 1993; 14: 159-161.
24.
Ramaswamy P, Lytrivi ID, Thanjan MT, Nguyen T, Srivastava S, Sharma S, Ko HH, Parness IA, Lai WW. Frequency of aberrant subclavian artery, arch laterality, and associated intracardiac anomalies detected by echocardiography. Am J Cardiol 2008; 101: 677-682.
25.
Carles D, Pelluard F, André G, Nocart N, Sauvestre F. L’artère sous-clavière droite aberrante (arteria lusoria) et le risque de trisomie 21. Analyse rétrospective de 11 479 examens fœtopathologiques. J Gynecol Obstet Biol Reprod 2014; 43: 698-703.
26.
Chaoui R, Heling KS, Sarioglu N, Schwabe M, Dankof A, Bollmann R. Aberrant right subclavian artery as a new cardiac sign in second- and third-trimester fetuses with Down syndrome. Am J Obstet Gynecol 2005; 192: 257-263.
27.
Fehmi Yazıcıoğlu H, Sevket O, Akın H, Aygün M, Özyurt ON, Karahasanoğlu A. Aberrant right subclavian artery in Down syndrome fetuses. Prenatal Diagnosis 2013; 33: 209-213.
28.
Rembouskos G, Passamonti U, De Robertis V, Tempesta A, Campobasso G, Volpe G, Gentile M, Volpe P. Aberrant right subclavian artery (ARSA) in unselected population at first and second trimester ultrasonography. Prenat Diagn 2012; 32: 968-75.
29.
Zalel Y, Achiron R, Yagel S, Kivilevitch Z. Fetal aberrant right subclavian artery in normal and Down syndrome fetuses. Ultrasound Obstet Gynecol 2008; 31: 25-29.
30.
Paladini D, Sglavo G, Pastore G, Masucci A, D’Armien- to MR, Nappi C. Aberrant right subclavian artery: incidence and correlation with other markers of Down syndrome in second-trimester fetuses. Ultrasound Obstet Gynecol 2012; 39: 191-195.
31.
Ranzini AC, Hyman F, Jamaer E, van Mieghem T. Aberrant right subclavian artery correlation between fetal and neonatal abnormalities and abnormal genetic screening or testing. J Ultrasound Med 2017; 36: 785-790.
32.
De León-Luis J, Gámez F, Bravo C, Tenías JM, Arias Á, Pérez R, Maroto E, Aguarón Á, Ortiz-Quintana L. Second-trimester fetal aberrant right subclavian artery: original study, systematic review and meta-analysis of performance in detection of Down syndrome. Ultrasound Obstet Gynecol 2014; 44: 147-153.
33.
Borenstein M, Minekawa R, Zidere V, Nicolaides KH, Allan LD. Aberrant right subclavian artery at 16 to 23+ 6 weeks of gestation: a marker for chromosomal abnormality. Ultrasound Obstet Gynecol 2010; 36: 548-552.
34.
Zschoch H. Zur Statistik angeborener Herz-und Gefäßmißbildungen. Zentralbl Pathol 1959; 100: 426-431.
35.
Janssen M, Baggen MG, Veen HF, Smout AJ, Bekkers JA, Jonkman JG, Ouwendijk RJ. Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy. Am J Gastroenterol 2000; 95: 1411-1416.
36.
Polguj M, Stefańczyk L, Topol M. The epidemiological, morphological, and clinical aspects of the aberrant right subclavian artery (Arteria Lusoria). Epidemiology of communicable and non-communicable diseases-attributes of lifestyle and nature on humankind. InTech, London, UK, 2016.
37.
Carrizo GJ, Marjani MA. Dysphagia lusoria caused by an aberrant right subclavian artery. Tex Heart Inst J 2004; 31: 168-171.
38.
Pyra K, Szmygin M, Sojka M, Jargiełło T. Successful endovascular treatment of ruptured giant aneurysm of arteria lusoria. Adv IntervCardiol 2020; 16: 356-357.