Aberrant subclavian artery causing difficulty in transhiatal esophageal dissection

Pramesh, C.S.; Saklani, Avanish; Parmar, Vani; Acharya, Sameer; Badwe, Rajan

doi:10.1046/j.1442-2050.2003.00322.x

Cited by 16 publications

(14 citation statements)

References 9 publications

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“…6 Second, because of the considerable danger of blunt mediastinal dissection during esophageal mobilization, a planned transhiatal approach may need to be converted to transthoracic esophagectomy, although this can be successful. 4,5 Third, the nonrecurrent right inferior laryngeal nerve that is associated with this anomaly may be injured during cervical lymphadenectomy, although lymphadenectomy in the upper mediastinum is easier to perform. Fourth, the thoracic duct may be injured if blind fi nger dissection is performed behind a previously unrecognized aberrant artery during transhiatal esophagectomy (Fig.…”

Section: Discussionmentioning

confidence: 98%

“…Moreover, there are very few reports of esophagectomy being performed for carcinoma of the thoracic esophagus in patients with an aberrant right subclavian artery. [4][5][6] To our knowledge, there are no previous reports describing pharyngolaryngoesophagectomy with gastric pull-up for hypopharyngeal and cervical esophageal carcinoma in a patient with an aberrant right subclavian artery. This anatomical situation presents several problems for the surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…3 There are few reports of esophagectomy for esophageal carcinoma in patients with an aberrant right subclavian artery. [4][5][6] We describe the surgical strategy we used to manage a case of carcinoma of the postcricoid region of the hypopharynx and cervical esophagus in a patient with an aberrant right subclavian artery.…”

Section: Introductionmentioning

confidence: 99%

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Pharyngolaryngoesophagectomy in a patient with an aberrant right subclavian artery: Report of a case

Sabljak¹,

Stojakov²,

Davidović

et al. 2011

Surg Today

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We report a case of carcinoma of the hypopharynx and cervical esophagus in a patient with an aberrant right subclavian artery. Barium esophagography, endoscopy, and computed tomography showed a resectable tumor in the hypopharynx and cervical esophagus, coexistent with an aberrant right subclavian artery. We performed pharyngolaryngoesophagectomy with bilateral neck dissection and gastric pull-up through cervical, right thoracic, and abdominal incisions. We also partially resected the aberrant right subclavian artery with reimplantation in the right common carotid artery. To our knowledge, this is the first report of pharyngolaryngoesophagectomy with transposition of an aberrant right subclavian artery.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Pharyngolaryngoesophagectomy in a patient with an aberrant right subclavian artery: Report of a case

Sabljak¹,

Stojakov²,

Davidović

et al. 2011

Surg Today

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“…In all patients of esophageal cancer with coexisting intrathoracic vascular anomalies, the course of the thoracic duct in the mediastinum might be varied . To avoid unnecessary accidental injury, the thoracic duct should be routinely ligated at 5 cm above the diaphragm.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and surgical treatment of esophageal carcinoma with coexistent intrathoracic vascular malformations

et al. 2014

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Background: The anomaly of intrathoracic large vessels might not only compress the esophagus resulting in dysphagia, but also hinder esophagectomy, even leading to uncontrolled massive hemorrhaging. This paper reviews our experience of seven patients with this diagnosis and their treatment. Methods: From January 2007 through January 2012, among patients admitted with esophageal carcinoma, there were seven patients confirmed to have coexisted intrathoracic vascular anomalies. They were six men and one woman, aged 52 to 63 (mean 58.42). The vascular anomalies included aberrant right subclavian artery (ARSA) in three cases, post-aortic left innominate vein (PALIV) in two cases, and one case each of right aortic arch (RAA) and pseudoaneurysm of aortic isthmus (PAAI). Their diagnosis, surgical strategy, and outcome were reviewed. Results: The vascular anomalies were missed by esophagography and endoscopy, but all identified by enhanced chest computed tomography (CT). Surgery was planned according to the anatomic features of the anomalies. ARSA did not need special management. RAA underwent left thoracotomy in order to dissect the aortopulmonary arterial ligament and to facilitate the mobilization of the esophagus. PAAI had preoperative aortic stenting to prevent unexpected aortic rupture. Prophylactic ligation of thoracic duct was performed on all patients and no postoperative chylothorax was documented. Conclusions:The coexistence of intrathoracic vascular malformations with esophageal carcinoma is rare, but easily missed in routine X-ray and endoscopy. Enhanced chest CT must be performed to confirm. Surgery should be designed individually in consideration of the anatomic features of the vascular anomalies. A routine prophylactic ligation of the thoracic duct is recommended.

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“…Essentially, right subclavian artery originates from the brachiocephalic artery, but in 0.4-1.8% of the general population it may arise directly from the aortic arch distal to the left subclavian artery. [ 1 2 3 ] ARSA on its way to the right arm crosses the midline posterior to esophagus.…”

Section: Introductionmentioning

confidence: 99%

Aberrant right subclavian artery: A life-threatening anomaly that should be considered during esophagectomy

Mahmodlou

Sepehrvand

Hatami

2014

J Surg Tech Case Report

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Aberrant right subclavian artery (ARSA) is a rare anomaly, in which the right subclavian artery arises directly from the aortic arch instead of originating from the brachiocephalic artery. This anomaly should be taken into consideration during surgical procedures around esophagus, such as esophagectomy. Any unintentional injury of this artery during surgical procedures could be extremely life threatening. A 56-year-old woman presented with dysphagia, with concurrent aberrant subclavian artery and esophageal cancer. The transhiatal esophagectomy was performed successfully since the anomaly was preoperatively diagnosed using computed tomography scan. 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.

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Aberrant subclavian artery causing difficulty in transhiatal esophageal dissection

Cited by 16 publications

References 9 publications

Pharyngolaryngoesophagectomy in a patient with an aberrant right subclavian artery: Report of a case

Pharyngolaryngoesophagectomy in a patient with an aberrant right subclavian artery: Report of a case

Diagnosis and surgical treatment of esophageal carcinoma with coexistent intrathoracic vascular malformations

Aberrant right subclavian artery: A life-threatening anomaly that should be considered during esophagectomy

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