Retroesophageal right subclavian artery associated with a bicarotid trunk and an ectopic origin of vertebral arteries

Abstract

A rare branching pattern of the aortic arch in a female cadaver is reported. An aberrant right subclavian artery originated from the distal part of the aortic arch and following a retroesophageal course was recognized. Next to it, from the left to the right, the left subclavian artery and a short bicarotid trunk originating the left and the right common carotid artery were recognized. An unusual origin of the vertebral arteries was also identified. The left vertebral artery originated directly from the aortic arch, whereas the right vertebral artery originated directly from the right common carotid artery. Retroesophageal right subclavian artery associated with a bicarotid trunk and ectopic origin of vertebral arteries represents an exceptional and noteworthy case.

Bicarotid trunk coexisting with anomalous right vertebral and aberrant right subclavian artery

“…Both unilateral and bilateral VA anomalies have been described coexisting with anomalous CCA and RSCA. While simultaneous ectopic origin of bilateral vertebral arteries is extremely rare, an ectopic left VA origin is relatively more common than the right amongst anomalous unilateral VA origins 2,3 . Our case is thus unique in describing the simultaneous occurrence of right vertebral and carotid artery anomalies in an uncommon left aortic arch branching pattern with aberrant right SCA.…”

“…Though usually isolated, it may be seen associated with other congenital defects. biCT, which is thought to arise due to embryological persistence of a common trunk giving rise to both carotids, may be seen in nearly one‐fifth of patients with aberrant right SCA 1,2 …”

“…As classically described, retroesophageal aberrant right SCA may be seen associated with dysphagia lusoria 4 Also, presence of biCT may lead to tracheobronchial compression and could limit tracheoesophageal mobility. 2,5 Anomalous VA origin may predispose to hemodynamic alterations which may cause cerebrovascular accidents. 3…”

The spectrum of computed tomography findings in blunt trauma of the subclavian/axillary artery: a pictorial essay

“…This pattern is appreciable in 70–80% of patients. 12 Anatomical variants are uncommon but should be described to optimize treatment: in 0.16–4.4% of cases, the right subclavian artery originates from the distal part of the aortic arch 13 , 14 , 15 and typically presents a retro-esophageal course (see Figure 1b ). Less frequent variants (incidence <1%) include a common carotid trunk (see Figure 1c ), in which both the subclavian arteries arise directly from the aortic arch, and the right aortic arch (see Figure 1d ), in which the pattern of emergence of the vessels from the aorta is mirrored.…”

Right Aortic Arch with Bicarotid Trunk and Aberrant Left Subclavian Artery

“…Association of bicarotid trunk with aberrant right SCA has been reported previously with origin of three or four arch vessels, including ectopic origin of vertebral arteries. 2 3 4 Moreover, associated CHD has been reported in 98.4% of patients with bicarotid trunk with VSD being the most common followed by pulmonary valve stenosis and atrial septal defect in a study including pediatric cardiology patients who underwent cardiac catheterization. 5 …”