Overview
Dysphagia lusoria is a symptom complex characterized by difficulty swallowing, typically caused by an aberrant right subclavian artery (ARSCA) or other vascular anomalies compressing the esophagus 123.Diagnosis
Key Diagnostic Criteria: Dysphagia, particularly with solid foods; imaging findings such as barium swallow studies and CT scans revealing ARSCA or other vascular anomalies 12.
Recommended Tests: Barium swallow, CT angiography, MRI/MRA 12.
Grading: No standardized grading system; clinical severity often assessed symptomatically 2.Management
First-Line Treatments: Surgical intervention, including reimplantation of ARSCA into the right carotid artery via partial median sternotomy or supraclavicular approaches 123.
Adjunctive Treatments: Hybrid endovascular techniques using devices like Amplatzer plugs for revascularization 5.
Endovascular Approaches: Combination with carotid subclavian bypass for complex cases 5.
Limited Surgical Approaches: Thoracotomy or muscle-sparing thoracotomy for division of vascular rings in adults 6.Special Populations
Pediatrics: Surgical reimplantation via partial median sternotomy or hybrid techniques show efficacy with complete symptom resolution 12.
Adults: Limited thoracotomy for division of vascular rings can be effective 6.
Comorbidities: Specific management strategies for comorbidities not extensively covered in abstracts; individualized surgical approaches recommended 36.Key Recommendations
Surgical reimplantation of ARSCA into the right carotid artery via partial median sternotomy or supraclavicular approach can effectively resolve dysphagia lusoria in pediatric patients (Evidence: Moderate 12).
For patients without a Kommerell diverticulum, a supraclavicular approach alone may suffice for symptom improvement (Evidence: Weak 3).
In adults with dysphagia lusoria due to vascular rings, limited thoracotomy for division of the compressing structures is a viable treatment option (Evidence: Weak 6).
Consider hybrid endovascular techniques using devices like Amplatzer plugs for complex cases requiring revascularization (Evidence: Expert opinion 5).References
1 An KR, Deng MX, Freud LR, Honjo O. Repair of Aberrant Right Subclavian Artery Causing Dysphagia Lusoria via Partial Median Sternotomy. World journal for pediatric & congenital heart surgery 2023. link
2 Nelson JS, Hurtado CG, Wearden PD. Surgery for Dysphagia Lusoria in Children. The Annals of thoracic surgery 2020. link
3 Dieffenbach BV, Sharma G, Shah SK, Menard MT, Belkin M. Aberrant subclavian artery division and revascularization by a supraclavicular approach for definitive or staged treatment of dysphagia lusoria. Journal of vascular surgery 2020. link
4 Fukuhara S, Patton B, Yun J, Bernik T. A novel method for the treatment of dysphagia lusoria due to aberrant right subclavian artery. Interactive cardiovascular and thoracic surgery 2013. link
5 Morris ME, Benjamin M, Gardner GP, Nichols WK, Faizer R. The use of the Amplatzer plug to treat dysphagia lusoria caused by an aberrant right subclavian artery. Annals of vascular surgery 2010. link
6 Sitzman TJ, Mell MW, Acher CW. Adult-onset dysphagia lusoria from an uncommon vascular ring: a case report and review of the literature. Vascular and endovascular surgery 2009. link