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

Abstract

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.

Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions

“…With a total of 39 included studies, for the 27 studies that had an N > 1, [24–50] the following data were collected: the total number of subjects included in the studies was 41,178 with an average ratio of 1.525:1 regarding the sex of the sample; 12 studies did not indicate the sex of their sample [25,27,31,34,35,37,38,45,47–50] ; one study by Yusuf et al [32] only indicates the sex of the sample that did present the anatomical variant and consisted of 10 men and 17 women, respectively; and, finally, 14 studies [24,26,28–30,33,39–44,46] show that the cumulative data for males was 2964/5393, which is equivalent to 54.9%, and cumulative data for females was 2429/5393, which is equivalent to 45.1%. Finally, regarding the geographical distribution of the included studies, [24–50,53–64] in 13 studies, the sample was European, which is equivalent to 33.3% of the included studies; in 12 studies, the sample was from North America, which is equivalent to 30.8% of the included studies; and, finally, 14 studies had a sample from Asia, which is equivalent to 35.9% of the studies included in this review (Table 2).…”

“…And in the third type, the artery runs anterior to the trachea. [66] For the included studies that could be classified according to their origin with respect to what was proposed by Williams et al, [66] 7 studies [32,54–56,59,63,64] reported the ARSA variant, showing the characteristics according to origin in 6 studies, [32,55,56,59,63,65] the variant is classified as type I in its origin, while 2 studies [54,55] showed that ARSA was classified as a different type of variant according to its origin and the classification. While 11 studies [24,29,32,55–57,59,61–64] in their description classified the route as type I, for the classification of type II, route 2 studies [24,59] presented this pattern; finally, for the type III route classification, no studies were presented (Tables 3 and 4).…”

“…studies [24,29,32,[55][56][57]59,[61][62][63][64] in their description classified the route as type I, for the classification of type II, route 2 studies [24,59] presented this pattern; finally, for the type III route classification, no studies were presented (Tables 3 and 4).…”

“…Does not present USA 10 patients. 1 male 9 female Middle ages: 48 ± yr Chen et al 2021 [31] Retrospective study (13, Behram et al 2021 [27] Retrospective study (11, [32] Retrospective study (7513) Retroesophageal ARSA in 27 exams (0.36%, 95% CI: 0.22%-0.50%) [59] Case study ARSA with course to the right between the trachea and the esophagus 100% incidence Does not present India 1 male Age: 35 yr Sadeghian et al 2020 [62] Case study ARSA with dysphagia 100% incidence Does not present USA 1 male Age: 52 yr Sabol et al 2019 [60] Case study Right aortic arch, aberrant left subclavian artery aortic coarctation 100% incidence Does not present Slovakia 1 female Age: 51 yr Sabljak et al 2011 [56] Case study Hypopharyngeal and cervical esophageal carcinoma with coexistence of ARSA 100% incidence Does not present Serbia 1 female Age: 65 yr Pramesh et al 2003 [53] Case study Esophageal carcinoma with coexistence of ARSA 100% incidence Does not present India 1 female Age: 52 yr Muraoka et al 2017 [33] Retrospective study (10) Aberrant left subclavian artery with or without stenosis 100% incidence Does not present Japan 10 fetuses: 6 male 4 female Age: 24-39 wk (Continued )…”

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

“…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.…”