Prevalence and Anatomy of Aberrant Right Subclavian Artery Evaluated by Computed Tomographic Angiography at a Single Institution in Korea

Abstract

ObjectiveAberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography. MethodsCT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA. ResultsSeventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia. ConclusionIt is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.

Aberran Subklavi̇an Arteri̇n Morfoloji̇k Ve Kli̇ni̇k Yönleri̇:tek Merkezli̇ Çkbt Tabanli Çalişma

“…Dysphagia due to esophageal compression is the most common symptom (dysphagia lusoria). Horner syndrome due to nerve compression and cough has also been reported 10 . ARSA was first described by Bayford in 1794 during the autopsy of a 62-year-old woman who died of dysphagia.…”

Single Centre Experience on Decision Making for Mechanical Thrombectomy Based on Single-Phase CT Angiography by Including NCCT and Maximum Intensity Projection Images – A Comparison with Magnetic Resonance Imaging after Non-Contrast CT

“…CTA has many advantages over NCCT, such as high sensitivity to LVO detection, visualization of carotid vessels, and tortuosity of aortic arch as part of stroke workup and thrombectomy planning, especially under conditions of difficult vessel anatomy (including femoral artery or radial artery approach) to select an appropriate approach to vessel access 29) . Structural variation in the aortic arch is rarely reported and should be considered in terms of the approach in the procedure 10) .…”

An Unrecognized Contraindication to Transesophageal Echocardiographic Probe Placement: The Aberrant Right Subclavian Artery

“…Given the prevalence of ARSA of 0.16% to 2% of the population and the fact that ARSAs are usually asymptomatic, patients may present to the operating room before this aortic arch anomaly is diagnosed. 1 , 2 With this in mind, it may be necessary to ensure appropriate right arm perfusion with TEE imaging in patients who have not undergone preoperative aortic arch imaging. Practitioners should consider undiagnosed ARSA in patients who exhibit decreased right arm perfusion during or soon after TEE probe placement.…”

“…The aberrant right subclavian artery (ARSA) is a vascular anomaly of the aortic arch, seen in 0.16% to 2% of the population, that originates distal to the left subclavian artery rather than its usual anatomic location from the brachiocephalic trunk ( Figure 1 ). 1 , 2 The ARSA tracks across the mediastinum to the right arm along a retroesophageal course in 85% of patients but can take courses between the esophagus and trachea or in front of the trachea. 3 , 4 An ARSA can cause symptoms such as dysphagia, cough, dyspnea, and chest pain, but the majority of patients with this anomaly are asymptomatic.…”