Hybrid treatment of dysphagia lusoria: right carotid to subclavian bypass and endovascular insertion of an Amplatzer II Vascular Plug

Abstract

Compression of the esophagus by a retroesophageal aberrant right subclavian artery (ARSA) is a rare cause of dysphagia. We present the case of a 47-year-old female with symptoms of progressive dysphagia diagnosed with dysphagia lusoria using barium swallow and contrast computed tomography and successfully treated with a hybrid procedure: right carotid to subclavian bypass and endovascular insertion of an Amplatzer II Vascular Plug through the right superficial femoral artery. We consider this approach safer, less invasive and more complete to avoid recurrent dysphagia.

Endovascular Repair With Triple Inner-Branch Endograft for Aberrant Subclavian Artery Aneurysm: A Case Report

“…For these reasons, surgeons should always be prepared to perform a stenting of the bypass or consider adjunctive therapeutic options, when C-S bypass precedes the endovascular procedure in days or weeks. As described in the literature, embolization of ARSA is a safe and minimally-invasive procedure 14 with a low risk of migration. 15 This procedure is necessary to avoid type II endoleak and to ensure sealing of the graft.…”

Dysphagia of aberrant right subclavian artery treated by endoscopic dilation: An alternative to surgical treatment in select cases—A case report

“…Different authors have proposed different surgical approaches. The most common surgical approaches include right supraclavicular extrathoracic approach, sternotomy/thoracotomy followed by transmediastinal approach, and combined use of endovascular and open vascular approaches, each with its own advantages and disadvantages [1,[4], [5], [6], [7], [8]].…”

“…Due to its course behind esophagus, it may be a rare cause of dysphagia in patients (also called ‘dysphagia lusoria’) [3]. Diagnosis can be made through chest computed tomography (CT), chest CT angiography (CTA) or magnetic resonance angiography (MRA) [4].…”

“…Although surgical intervention has remained the mainstem of therapy [1], the best surgical approach also remains controversial [5]. Different approaches include hybrid vascular and endovascular repair [4], and direct surgical repair. The latter can be obtained through a variety of corridors including extrathoracic [[5], [6], [7], [8]], or transthoracic (thoracotomy) [9,10], all accompanied with certain morbidities and mortalities.…”

Double approach in a pediatric patient with dysphagia lusoria due to aberrant right subclavian artery

“…Only long-term follow-up can determine the safety of these devices (Figure 1). 6 Restoration of anterograde blood flow to the right upper extremity as well as digestive decompression are the goals of surgical treatment. The double approach has been described for the resolution of said pathology, as mentioned by Nelson et al, performing left thoracotomy and median sternotomy, although it could be said that they are more invasive methods, they had a good evolution with discharge in less than 7 days (Figure 2).…”