Repair of Aberrant Right Subclavian Artery Causing Dysphagia Using a Hybrid Approach
Lauren Story, Mohammed Moursi
University of Arkansas for Medical Sciences, Little Rock, AR
Here we present a hybrid approach for the treatment of a symptomatic aberrant right subclavian artery.Dysphagia due to an aberrant right subclavian artery is a known condition. However, it is uncommon in children. We present a 9 y/o male who presented with dysphagia, odynophagia, and globus sensation. He had to drink some water with every bite in order to eat. His workup included an EGD, upper GI and CTA. All of these showed compression of the esophagus by the aberrant right subclavian artery. We planned a hybrid approach with thoracoscopy and standard open techniques. The patient was taken to the operating room and placed with his right side up. Five thoracoscopy ports were placed and the aberrant right subclavian artery was identified and skeletonized along its course from the aortic take-off to the point that it exited the thoracic cage. The azygos vein was ligated. The aberrant right subclavian was ligated using an endostapler. The patient was then placed supine and a supraclavicular incision was used to identify the right common carotid and aberrant subclavian. The subclavian artery was mobilized and completely pulled out of the chest. Control was obtained and an end of subclavian to side of carotid artery anastomosis was performed with a running 7-0 prolene. Post-op, the patient had complete resolution of his dysphagia and had a palpable right radial pulse. His post-op EDG showed complete resolution of the esophageal compression.
Questions:
A. An aberrant right subclavian artery causes dysphagia by the following
- distension of the left recurrent laryngeal nerve
- Ischemia of the upper esophagus
- decrease vertebral blood flow
- compression of the esophagus as the artery passes in a retro-esophageal route (correct answer)
- TEVAR coverage of the right subclavian
- Left carotid to subclavian artery
- Embolization of right subclavian with an amplatzer plug
- Hybrid approach using thorascopic ligation of subclavian followed by a right carotid subclavian transposition (correct answer)
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