Aberrant subclavian artery causing difficulty in transhiatal esophageal dissection

Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Diseases of the Esophagus (Impact Factor: 1.78). 02/2003; 16(2):173-6. DOI: 10.1046/j.1442-2050.2003.00322.x
Source: PubMed


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: An aberrant right subclavian artery (ARSA) is an anatomical abnormality that occurs at a frequency of 0.4–2 %. It is important to be aware of this abnormality when performing radical esophagectomy for esophageal cancer because many patients with an ARSA have a right nonrecurrent inferior laryngeal nerve (NRILN) and right thoracic duct. We report three cases of esophageal cancer with ARSA treated by thoracoscopic esophagectomy. Case 1 was a 59-year-old woman with a relapse of a thoracic esophageal cancer after definitive chemoradiotherapy (CRT). Case 2 was a 76-year-old man with upper thoracic esophageal cancer who had received no treatment before the surgery. Case 3 was a 69-year-old man with upper thoracic esophageal cancer pretreated with neoadjuvant CRT. It was possible to predict an ARSA by computed tomography and the right thoracic ducts by magnetic resonance imaging before surgery in all three cases. Thoracoscopic esophagectomy with two-field lymph node dissection was performed, and the NRILN and the right thoracic duct were detected and preserved in all three cases. Because of ARSA, the operative field is limited around the left recurrent nerve, so a careful procedure is needed to avoid nerve palsy.
    Esophagus 09/2013; 10(3). DOI:10.1007/s10388-013-0363-y · 0.74 Impact Factor
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    ABSTRACT: It is necessary to dissect recurrent nerve lymph nodes to improve the surgical prognosis of patients with esophageal cancer 1 , so the anatomy of bilateral recurrent nerves must be identified during the operation. In rare cases a recurrent nerve is non-recurrent, branching directly from the vagus trunk 2 . This anomaly of a right non-recurrent recurrent nerve is closely associated with an aberrant right subclavian artery 3,4 , which can be recognized on enhanced computed tomography. We present a rare case of esophageal cancer with an aberrant right subclavian artery. SUMMARY We report a rare case of esophageal carcinoma accompanied by an aberrant right subclavian artery. Esophagectomy was performed on a 74-year-old man with esophageal cancer and a right retroesophageal subclavian artery was found during the operation. This brought some anatomical problems: a right recurrent nerve could not be identified when right paratracheal lymph nodes in the mediastinum were dissected. It is important for the operation to dissect recurrent nerve lymph nodes, so computed tomography CT must be examined in detail preoperatively because a right inferior laryngeal nerve is not recurrent if a right subclavian artery arises from the posterior wall of the aortic arch as its last branch and runs rightwards and upwards between the esophagus and the vertebra.
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    ABSTRACT: We report a case of carcinoma of the hypopharynx and cervical esophagus in a patient with an aberrant right subclavian artery. Barium esophagography, endoscopy, and computed tomography showed a resectable tumor in the hypopharynx and cervical esophagus, coexistent with an aberrant right subclavian artery. We performed pharyngolaryngoesophagectomy with bilateral neck dissection and gastric pull-up through cervical, right thoracic, and abdominal incisions. We also partially resected the aberrant right subclavian artery with reimplantation in the right common carotid artery. To our knowledge, this is the first report of pharyngolaryngoesophagectomy with transposition of an aberrant right subclavian artery.
    Surgery Today 08/2011; 41(8):1112-6. DOI:10.1007/s00595-010-4421-y · 1.53 Impact Factor
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