Aberrant subclavian artery causing difficulty in transhiatal esophageal dissection.

Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Diseases of the Esophagus (Impact Factor: 2.06). 02/2003; 16(2):173-6. DOI: 10.1046/j.1442-2050.2003.00322.x
Source: PubMed

ABSTRACT The right subclavian artery normally arises from the brachiocephalic artery. Anomalies in development may lead to peculiar problems during surgery. We report a patient with esophageal carcinoma who had an aberrant right subclavian artery, posing specific difficulties during a transhiatal esophagectomy, requiring conversion of the procedure into a transthoracic approach. The embryologic basis of this anomaly and the clinical significance are discussed.

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    ABSTRACT: Aberrant right subclavian artery (ARSA) is a rare anomaly, in which the right subclavian artery arises directly from the aortic arch instead of originating from the brachiocephalic artery. This anomaly should be taken into consideration during surgical procedures around esophagus, such as esophagectomy. Any unintentional injury of this artery during surgical procedures could be extremely life threatening. A 56-year-old woman presented with dysphagia, with concurrent aberrant subclavian artery and esophageal cancer. The transhiatal esophagectomy was performed successfully since the anomaly was preoperatively diagnosed using computed tomography scan. The presence of ARSA during esophagectomy may be challenging, but if diagnosed preoperatively, the precise and diligent dissection of the retroesophageal space during esophagectomy, may prevent any injury to the aberrant artery and consequent complications.
    07/2014; 6(2):61-3. DOI:10.4103/2006-8808.147262
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    ABSTRACT: Background The anomaly of intrathoracic large vessels might not only compress the esophagus resulting in dysphagia, but also hinder esophagectomy even lead to uncontrolled massive hemorrhage. This paper reviews our experience of 7 patients on the diagnosis and treatment for such entity. Methods From January 2007 through January 2012, among patients with esophageal carcinoma admitted there were 7 patients confirmed to have co-existed intrathoracic vascular anomalies. They were 6 males and 1 female, aged 52 to 63 years and 58.42 years on average. The vascular anomalies included aberrant right subclavian artery (ARSA) for 3 cases, post-aortic left innominate vein (PALIV) for 2 cases, right aortic arch (RAA) and pseudoaneurysm of aortic isthmus (PAAI) 1 case for each. Their diagnosis, surgical strategy and outcome were reviewed. ResultsThe vascular anomalies were missed by esophagography and endoscopy but all identified by enhanced chest CT. Surgery was planned according to the anatomic features of the anomalies. ARSA did not need special management. RAA underwent left thoracotomy in order to dissect the aortopulmonary arterial ligament and to facilitate the mobilization of the esophagus. PAAI had preoperative aortic stenting to prevent unexpected aortic rupture. Prophylactic ligation of thoracic duct was performed on all patients and had no postoperative chylothorax documented. Conclusions The co-existence of intrathoracic vascular malformations with esophageal carcinoma is rare but easily missed in the routine x-ray and endoscopy. It needs enhanced chest CT to confirm. Surgery should be designed individually in consideration of the anatomic features of the vascular anomalies. A routine prophylactic ligation of thoracic duct is recommended.
    02/2014; 5(5). DOI:10.1111/1759-7714.12103
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    ABSTRACT: Right non-recurrent inferior laryngeal nerve is a rare nerve anomaly that communicates the right vagal nerve trunk to the laryngeal nerve directly in the neck, and is usually accompanied by an aberrant right subclavian artery. We report a case of thoracic esophagectomy with intraoperative neuromonitoring undertaken in a patient with these abnormalities. This case report concerns a 66-year-old man with thoracic esophageal carcinoma who was referred to our hospital. An aberrant right subclavian artery that gave us a prediction of a right non-recurrent inferior laryngeal nerve was detected preoperatively using computed tomography, and identified visually with intraoperative neuromonitoring. Identification of this nerve anomaly during cervical lymph node dissection was considered important to avoid unexpected neural injuries. For a successful esophagectomy with lymph node dissection in patients with this anomaly, intraoperative neuromonitoring for the non-recurrent inferior laryngeal nerve may provide a useful contribution to surgical safety.
    Esophagus 01/2015; DOI:10.1007/s10388-015-0493-5 · 0.74 Impact Factor