Journal of Korean Neurosurgical Society

  • 제62권2호
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  • Pages.175-182
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  • 2019
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Prevalence and Anatomy of Aberrant Right Subclavian Artery Evaluated by Computed Tomographic Angiography at a Single Institution in Korea

  • 투고 : 2018.03.06
  • 심사 : 2018.04.30
  • 발행 : 2019.03.01
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초록

Objective : Aberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography. Methods : CT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA. Results : Seventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia. Conclusion : It is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.

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참고문헌

  1. Babu CS, Sharma V : Two common trunks arising from arch of aorta: case report and literature review of a very rare variation. J Clin Diagn Res 9 : AD05-AD07, 2015
  2. Backer CL, Ilbawi MN, Idriss FS, DeLeon SY : Vascular anomalies causing tracheoesophageal compression. Review of experience in children. J Thorac Cardiovasc Surg 97 : 725-731, 1989 https://doi.org/10.1016/S0022-5223(19)34517-9
  3. Bayford D : An account of singular case of obstructed deglutition. Mem Med Soc Lond 2 : 275-286, 1794
  4. Berko NS, Jain VR, Godelman A, Stein EG, Ghosh S, Haramati LB : Variants and anomalies of thoracic vasculature on computed tomographic angiography in adults. J Comput Assist Tomogr 33 : 523-528, 2009 https://doi.org/10.1097/RCT.0b013e3181888343
  5. Celikyay ZR, Koner AE, Celikyay F, Deniz C, Acu B, Firat MM : Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data. Clin Imaging 37 : 1011-1019, 2013 https://doi.org/10.1016/j.clinimag.2013.07.008
  6. Chadha NK, Chiti-Batelli S : Tracheostomy reveals a rare aberrant right subclavian artery; a case report. BMC Ear Nose Throat Disord 4 : 1, 2004 https://doi.org/10.1186/1472-6815-4-1
  7. Desvant C, Chevalier D, Mortuaire G : Tracheotomy bleeding from an unusual tracheo-arterial fistula: involvement of an aberrant right subclavian artery. J Laryngol Otol 124 : 1333-1336, 2010 https://doi.org/10.1017/S0022215110001362
  8. Gable DS, Stoddard LD : Acute bacterial aortitis resulting in an aortoesophageal fistula. A fatal complication of untreated esophageal carcinoma. Pathol Res Pract 184 : 318-324, 1989 https://doi.org/10.1016/S0344-0338(89)80093-7
  9. Heck HA Jr, Moore HV, Lutin WA, Leatherbury L, Truemper EJ, Steinhart CM, et al. : Esophageal-aortic erosion associated with double aortic arch and tracheomalacia. Experience with 2 infants. Tex Heart Inst J 20 : 126-129, 1993
  10. Hosn MA, Haddad F, El-Merhi F, Safadi B, Hallal A : Repair of an aberrant subclavian arterioesophageal fistula following esophageal stent placement. World J Gastrointest Surg 6 : 117-121, 2014 https://doi.org/10.4240/wjgs.v6.i6.117
  11. Huang IL, Hwang HR, Li SC, Chen CK, Liu CP, Wu MT : Dissection of arteria lusoria by transradial coronary catheterization: a rare complication evaluated by multidetector CT. J Chin Med Assoc 72 : 379-381, 2009 https://doi.org/10.1016/S1726-4901(09)70391-0
  12. Ichikawa T, Koizumi J, Tanno K, Okochi T, Nomura T, Shimura S, et al. : Kommerell diverticulum in adults: evaluation of routine CT examinations. Tokai J Exp Clin Med 41 : 65-69, 2016
  13. Inman JC, Kim P, McHugh R : Retroesophageal subclavian artery--esophageal fistula: a rare complication of a salivary bypass tube. Head Neck 30 : 1120-1123, 2008 https://doi.org/10.1002/hed.20854
  14. Jahnke T, Schaefer PJ, Heller M, Mueller-Huelsbeck S : Interventional management of massive hemothorax due to inadvertent puncture of an aberrant right subclavian artery. Cardiovasc Intervent Radiol 31 : Suppl 2:S124-S127, 2008 https://doi.org/10.1007/s00270-007-9177-4
  15. Jakanani GC, Adair W : Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol 65 : 481-487, 2010 https://doi.org/10.1016/j.crad.2010.02.003
  16. Jalali Kondori B, Asadi MH, Rahimian E, Tahsini MR : Anatomical variations in aortic arch branching pattern. Arch Iran Med 19 : 72-74, 2016
  17. Janssen M, Baggen MG, Veen HF, Smout AJ, Bekkers JA, JG, et al. : Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy. Am J Gastroenterol 95 : 1411-1416, 2000 https://doi.org/10.1111/j.1572-0241.2000.02071.x
  18. Jiang XH, Zhu XY : Abnormal origin of the right subclavian artery: a case report. Chin Med J (Engl) 130 : 1508-1509, 2017 https://doi.org/10.4103/0366-6999.207463
  19. Kiernan PD, Dearani J, Byrne WD, Ehrlich T, Carter W, Krasicky G, et al. : Aneurysm of an aberrant right subclavian artery: case report and review of the literature. Mayo Clin Proc 68 : 468-474, 1993 https://doi.org/10.1016/S0025-6196(12)60196-7
  20. Levitt B, Richter JE : Dysphagia lusoria: a comprehensive review. Dis Esophagus 20 : 455-460, 2007 https://doi.org/10.1111/j.1442-2050.2007.00787.x
  21. Malone CD, Urbania TH, Crook SE, Hope MD : Bovine aortic arch: a novel association with thoracic aortic dilation. Clin Radiol 67 : 28-31, 2012 https://doi.org/10.1016/j.crad.2011.04.004
  22. Maranillo E, Vazquez T, Quer M, Niedenfuhr MR, Leon X, Viejo F, et al. : Potential structures that could be confused with a nonrecurrent inferior laryngeal nerve: an anatomic study. Laryngoscope 118 : 56-60, 2008 https://doi.org/10.1097/MLG.0b013e318156a04a
  23. Merchant FJ, Nichols RL, Bombeck CT : Unusual complication of nasogastric esophageal intubation-erosion into an aberrant right subclavian artery. J Cardiovasc Surg (Torino) 18 : 147-150, 1977
  24. Miller RG, Robie DK, Davis SL, Cooley DA, Klish WJ, Skolkin MD, et al. : Survival after aberrant right subclavian artery-esophageal fistula: case report and literature review. J Vasc Surg 24 : 271-275, 1996 https://doi.org/10.1016/S0741-5214(96)70103-9
  25. Moorehead PA, Kim AH, Miller CP, Kashyap TV, Kendrick DE, Kashyap VS : Prevalence of bovine aortic arch configuration in adult patients with and without thoracic aortic pathology. Ann Vasc Surg 30 : 132-137, 2016 https://doi.org/10.1016/j.avsg.2015.05.008
  26. Muller M, Schmitz BL, Pauls S, Schick M, Rohrer S, Kapapa T, et al. : Variations of the aortic arch - a study on the most common branching patterns. Acta Radiol 52 : 738-742, 2011 https://doi.org/10.1258/ar.2011.110013
  27. Natsis K, Didagelos M, Manoli SM, Papathanasiou E, Sofidis G, Anastasopoulos N : A bicarotid trunk in association with an aberrant right subclavian artery. Report of two cases, clinical impact, and review of the literature. Folia Morphol (Warsz) 70 : 68-73, 2011
  28. Natsis KI, Tsitouridis I A, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD : Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat 31 : 319-323, 2009 https://doi.org/10.1007/s00276-008-0442-2
  29. Nelson ML, Sparks CD : Unusual aortic arch variation: distal origin of common carotid arteries. Clin Anat 14 : 62-65, 2001 https://doi.org/10.1002/1098-2353(200101)14:1<62::AID-CA1012>3.0.CO;2-#
  30. Sukumaran TT, Pillay M, Gopalakrishnan A : An anomalous right subclavian artery with a retrotracheal course: a case report. J Clin Diagn Res 9 : AD01-AD02, 2015
  31. Thorpe SW, Hohl JB, Gilbert S, Tannoury CA, Lee JY : Aberrant right subclavian artery encountered during debridement of T2 osteomyelitis and associated phlegmon. Spine J 11 : e6-e10, 2011 https://doi.org/10.1016/S1529-9430(10)01366-5
  32. Tubbs RS, Oakes WJ, Salter EG, Zehren SJ : Retroesophageal right subclavian artery with persistent ductus arteriosus. Anat Sci Int 79 : 98-100, 2004 https://doi.org/10.1111/j.1447-073x.2004.00068.x
  33. Vucurevic G, Marinkovic S, Puskas L, Kovacevic I, Tanaskovic S, Radak D, et al. : Anatomy and radiology of the variations of aortic arch branches in 1,266 patients. Folia Morphol (Warsz) 72 : 113-122, 2013 https://doi.org/10.5603/FM.2013.0019

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