A New Method for Demonstrating an Aberrant Right Subclavian Artery

Abstract

There are numerous autopsy reports of aberrant right subclavian artery. The first authenticated case was observed postmortem in 1735 by Hunauld, and Bayford in 1794 designated the dysphagia that may result from such an anomaly as “dysphagia lusoria.” Holzapfel, in 1899, recorded 133 instances discovered at autopsy (6). This is generally stated to be the most common of the congenital anomalies of the aortic arch (7), the incidence being given variously as 4 per thousand autopsies (9) to 12 per thousand (4). The first report of an antemortem diagnosis of aberrant right subclavian artery was in the foreign literature; only in recent years have references to this anomaly appeared in the American literature. Copleman in 1945 described a case and was able to find only four reported cases up to that time in which the diagnosis was made during life (1, 3). Stauffer and Pote in 1946 (8) further stimulated interest in this anomaly, and Neuhauser in the same year (7) discussed it. Brean and Neuhauser in 1947 collected a series of cases associated with patent ductus arteriosus (2). An anomalous right subclavian artery, in the majority of instances, is asymptomatic, though occasionally it may interfere with swallowing by pressing upon the esophagus. Symptoms may arise at any age, and in such cases it is possible to provide complete relief by severing the artery and removing it from behind the esophagus (5). The authors referred to above and other investigators have adequately discussed the embryology and anatomy of an aberrant right subclavian artery (2, 8). The roentgenologic finding of an oblique extrinsic defect upon the barium-filled esophagus, usually just above the aortic knob, passing upward from left to right, has been clearly diagrammed and illustrated. The lesion is often seen best in the right anterior oblique position, but it is also evident in the postero-anterior projection as a defect on the left lateral aspect of the esophagus with a concavity to the left. Copleman points out that often the aberrant vessel arises from a diverticulum-like out-pouching on the adult aorta, and that this “diverticulum” may produce another lower and larger defect in the esophagus with a concavity to the right, resulting in a reverse “S” appearance. The purpose of our report is to present a new method for demonstrating the course of an aberrant right subclavian artery when this is suspected during barium studies of the esophagus. The right brachial artery is punctured with a No. 19 special thin-walled needle through which a radiopaque catheter, 70 cm. in length,3 is inserted into the artery. Under fluoroscopic control, the catheter is advanced through the brachial and subclavian arteries into the descending portion of the aortic arch. Fluoroscopy and roentgenograms with the catheter in place, within the lumen of the vessel, demonstrate the actual course of the subclavian artery and its entrance into the aorta.