VOKA
Categories
Congenital Heart DefectsAtrial septal defect, Tetralogy of Fallot, Coarctation of the aorta
DentistryCaries, Pulp pathology, Apical periodontitis, Non-carious lesions
Acquired Heart DiseasesCoronary arteries atherosclerosis, Valvular heart disease, Cardiomyopathy
ObstetricsFetal presentation, Placenta previa, Fetal lie
GynecologyVaginitis, Bartholinitis, Cervicitis, Endometriosis, Leiomyoma of the uterus
CNS and PNS DisordersEpidural hemorrhage, Subdural hemorrhage, Skull fractures
Liver DiseasesCholelithiasis, Hepatic cirrhosis, Cholecystitis
Respiratory System DiseasesHemothorax, Complications of hemothorax, Pneumothorax
Eye DisordersConjunctivitis, Degenerative disorders of conjunctiva
Vascular DiseasesArterial aneurysms, Atherosclerosis, Venous diseases
OtorhinolaryngologyDevelopmental abnormalities of the external ear, External ear injuries

Aberrant subclavian artery

Table of contents
Anatomic Pathology Pathophysiology Classification Clinical Manifestations Diagnosis Treatment

This pathology model shows a type I aberrant right subclavian artery combined with a rare anatomical variation of aortic arch branching pattern known as a bicarotid trunk. It means that the left and right common carotid arteries stem from the aortic arch as one trunk.

Anatomic Pathology

The aberrant right subclavian artery originates from the aortic arch, distal to the left subclavian artery. Typically, it courses between the esophagus and the trachea, and in rare cases, anterior to the trachea. 

Pathophysiology

The aberrant right subclavian artery tends to compress the esophagus and/or trachea, which in turn impairs respiration and swallowing. If an aneurysm develops, it may exacerbate compression-related symptoms, trigger thromboembolic complications, and lead to bleeding if ruptured. Over time, occlusive diseases such atherosclerosis and thrombosis decrease blood supply to the subclavian arterial territory.

Classification

  • Type I: The aberrant artery has no signs of aneurysmal dilation; only the esophagus and/or trachea are compressed.
  •  Type II: Occlusive damage to the aberrant right subclavian artery with no signs of aneurysmal dilation is observed. 
  • Type III: The artery has an aneurysmal dilatation; the aorta remains unaffected.
  • Type IV: The artery has an aneurysmal dilatation; the aorta is affected.

Clinical Manifestations

The disease generally presents with dysphagia and sometimes breathing problems. Ischemic and thromboembolic complications may also develop but are less common.

Diagnosis

Doppler ultrasound: visualization of the abnormal artery; blood flow assessment.

CT/MRI: visualization of the aberrant subclavian artery, its location, and size assessment.

Treatment

Surgical intervention may be preferred if the aberrant subclavian artery compresses the esophagus and/or trachea. Surgery aims to reposition the artery to alleviate the pressure. In cases of aneurysmal dilation, arterial grafting may also be required.