Transhiatal esophagectomy on a patient with aberrant right subclavian artery: A case report.

INTRODUCTION: Esophageal dissection is generally safe and easy during transhiatal esophagectomy (THE). The right subclavian artery crosses between the esophagus and spine in about 1 % to 2 % of cases. This condition is called aberrant right subclavian artery and is the most common congenital aortic arch anomaly. Pre-operative recognition of this anomaly is important in esophageal surgeries. In unprepared situations injury to this vessel may result in life threatening bleeding. CASE PRESENTATION: A 45 year old female patient presented with progressive dysphagia and weight loss. Esophageal mass was found during upper gastrointestinal endoscopy. Additionally, a CT scan of the thorax and abdomen revealed an aberrant right subclavian artery and a distal esophageal mass. Biopsy revealed squamous cell carcinoma. A transhiatal esophagectomy was performed successfully with no complications. DISCUSSION: The vast majority of patients with an aberrant right subclavian artery do not experience any symptoms. In rare cases, patients may present with dysphagia (dysphagia lusoria) and obstructive respiratory symptoms in their fourth or fifth decade. When patients present with dysphagia from esophageal cancer, careful review of imaging is needed to identify the aberrant artery. CONCLUSION: The presence of aberrant right subclavian artery causes difficulty in performing esophagectomy. If it is diagnosed preoperatively, cautious retroesophageal dissection prevents injury to this vessel and complications following it.

Arteria subclavia aberrante / Aberrant subclavian artery

Se estudiaron las variaciones en el origen y trayecto de la arteria subclavia derecha aberrante, observada en un cadáver utilizado para docencia de anatomía humana. En este caso, el arco aórtico da origen a cuatro ramas separadas, que de derecha a izquierda son: arteria carótida común derecha, arteria carótida común izquierda, arteria subclavia izquierda y arteria subclavia derecha. Desde este origen, la arteria subclavia derecha transcurre por detrás de la tráquea y del esófago, a la altura del cuerpo vertebral de T III, para luego retomar su trayecto normal hacia la raíz del cuello. Se midieron los diámetros del arco aórtico y de sus ramas. Asimismo, se consignaron los díametros y la distancia de origen de ambas arterias vertebrales, desde las arterias subclavias. Esto se realizó con el objeto de analizar posibles asimetrías importantes relacionadas con la aparición de esta variación. En el texto se discuten las probables razones embriológicas que permiten explicar el origen anómalo de la arteria subclavia derecha.

The anatomical variations involving the origin and passage of the right aberrant subclavian artery were studied, based on findings in a cadaver used for human anatomy teaching. In this case, the aortic arch gives rise to four separated branches, from right to left: right common carotid artery, left common carotid artery, left subclavian artery and right subclavian artery. From its origin, the right subclavian artery runs behind the trachea and esophagus, at the level of the third thoracic vertebrae, afterwards it reassumes its normal passage to the neck. The diameter of the aortic arch and its four branches were measured. In both vertebral arteries the diameter and distance from its origin in the subclavian arteries to the origin of the subclavian arteries were measured, with the purpose of analyzing potential important asymmetries. The probable embryologic explanations for this anomaly are discussed.