ARTERIA LUSORIA

ARTERIA LUSORIA


Arteria lusoria, also known as an aberrant right subclavian artery (ARSA), is a congenital vascular anomaly where the right subclavian artery arises abnormally from the descending aorta instead of the brachiocephalic trunk. This anomaly is found in about 0.5-2% of the population.

Pathophysiology:

  • In a typical anatomical arrangement, the right subclavian artery arises from the brachiocephalic trunk, which branches off from the aortic arch. In arteria lusoria, the right subclavian artery originates from the distal aortic arch or proximal descending aorta and passes behind the esophagus to supply the right arm.

  • This abnormal course can sometimes compress surrounding structures, such as the esophagus or trachea, leading to clinical symptoms, though many individuals remain asymptomatic.

Clinical Features:

  1. Dysphagia lusoria: The most common symptom, characterized by difficulty in swallowing due to the compression of the esophagus by the aberrant artery.
  2. Respiratory symptoms: In some cases, the aberrant artery may compress the trachea, leading to wheezing, cough, or dyspnea.
  3. Neurological or vascular symptoms: Rarely, due to altered blood flow, patients may experience upper limb ischemia or even steal syndrome (blood is “stolen” from other areas to supply the subclavian artery).

Diagnosis:

  • Imaging:
    • CT angiography and MR angiography are commonly used to confirm the diagnosis by visualizing the aberrant course of the artery.
    • Barium swallow: This imaging modality can show esophageal compression in patients presenting with dysphagia.
  • Chest X-ray and echocardiography can sometimes show indirect signs of this condition.

Treatment:

  • In asymptomatic cases, no treatment is typically necessary.
  • Symptomatic cases, particularly those with dysphagia lusoria, may require surgical correction, where the aberrant artery is repositioned or ligated to relieve compression.

Prognosis:

  • The majority of patients with arteria lusoria remain asymptomatic throughout life. Symptomatic cases that require intervention generally have a good prognosis following surgery.
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