Cervical origin of left subclavian artery: A rare anomaly

Abstract

A 22-year-old lady was referred to our institute for the management of pulmonary atresia with hypoplastic pulmonary arteries. Computed tomographic Angiography (CTA) showed right aortic arch with left brachicephalic artery as the first branch, which trifurcated into internal carotid, external carotid and subclavian artery high up in the neck at the level of third cervical vertebra. The left subclavian artery then travelled back caudally and entered into the arm after giving rise to a large collateral artery. This is the first ever-reported case of cervical origin of left subclavian artery (COLSA) in the literature. This anomaly can be explained by the absence of left fourth aortic arch with left subclavian artery arising from the left third aortic arch.

The importance of recognizing a cervical origin of the right subclavian artery

“…Only one case of cervical origin of the left subclavian artery has been reported in the literature . This case was likely associated with DiGeorge syndrome, although genetic testing was not undertaken .…”

“…1 This case was likely associated with DiGeorge syndrome, although genetic testing was not undertaken. 1 The authors explain this anomaly as occurring due to agenesis of the left fourth arch before the involution of left ductus caroticus, which is a segment of the dorsal aorta between the third and fourth arches. 1 The connection between third arch and seventh intersegmental artery was bridged by the retained ductus caroticus.…”

“…1 The authors explain this anomaly as occurring due to agenesis of the left fourth arch before the involution of left ductus caroticus, which is a segment of the dorsal aorta between the third and fourth arches. 1 The connection between third arch and seventh intersegmental artery was bridged by the retained ductus caroticus. 1 The preoperative or intraoperative identification of a CORSA is important for surgeons operating on patients requiring surgery in the lateral neck, carotid sheath, or in cardiothoracic procedures.…”

“…1 The connection between third arch and seventh intersegmental artery was bridged by the retained ductus caroticus. 1 The preoperative or intraoperative identification of a CORSA is important for surgeons operating on patients requiring surgery in the lateral neck, carotid sheath, or in cardiothoracic procedures. Although rare, a CORSA may be identified preoperatively using routine radiological studies.…”

“…Surgeons should be familiar with the vascular anatomy and variations of the RSA when operating in the lateral compartment in order to prevent a life‐threatening complication. A cervical origin of the right subclavian artery (CORSA) is an extremely rare occurrence, and is usually associated with other cardiovascular anomalies and the DiGeorge syndrome . We report a case of isolated CORSA and discuss the embryology and possible genetic basis of this anatomical abnormality, as well as techniques to identify it.…”