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Compression of esophagus — Clinical Guidelines

Overview

An aberrant subclavian artery (ASA), also known as arteria lusoria, is a congenital anomaly characterized by the origin of the subclavian artery from the aortic arch at an abnormal location, often compressing adjacent structures such as the esophagus, leading to symptoms like dysphagia or respiratory issues. 4 14 15

Diagnosis

Clinical Symptoms: Dysphagia, respiratory distress, and symptoms related to compression of adjacent structures. 4 14 15

Imaging Techniques:

- Barium Swallow: Reveals anterior indentation of the esophagus. 14 15 - Angiography: Confirms the anatomical variant and associated pathologies like aneurysms or Kommerell's diverticulum. 13 14 - CT and MR Angiography: Useful for detailed visualization of the aberrant artery and associated complications. 13

Management

Surgical Approaches:

- Transection and Reimplantation: For symptomatic cases, transection of the aberrant artery with reimplantation into the common carotid artery or subclavian artery. 14 - Hybrid Techniques: Combining open and endovascular methods, particularly useful in cases with associated aneurysms or Kommerell's diverticulum. 12 11 - Mediastinoscopy-Assisted Ligation: Ligation at the origin with subclavian-carotid transposition for specific anatomical variants. 10

Endovascular Repair: Used for isolated aberrant subclavian artery aneurysms or when open surgery is contraindicated. 7 12

Special Populations

Pregnancy: No specific guidelines provided in the abstracts regarding management during pregnancy. 1

Pediatrics: Management often depends on symptomatology; surgical intervention reserved for symptomatic cases. 14

Elderly: Considerations for comorbidities and surgical risk stratification are crucial; hybrid techniques may offer less invasive options. 9

Comorbidities: Patients with associated aneurysms or Kommerell's diverticulum may require more aggressive intervention. 6 16

Key Recommendations

Symptomatic Patients Should Undergo Surgical Intervention: Transection and reimplantation or hybrid techniques for symptomatic aberrant subclavian artery compressing critical structures. (Evidence: Moderate 14 11)

Imaging with Barium Swallow and Angiography is Essential for Diagnosis: Confirming the anatomical variant and assessing compression effects. (Evidence: Moderate 14 13)

Endovascular Approaches Should Be Considered for Isolated Aneurysms: Particularly beneficial in high-risk surgical candidates. (Evidence: Moderate 7 12)

Management Strategies Vary Based on Anatomical Complexity and Symptom Severity: Tailoring treatment from conservative to hybrid or open surgical methods. (Evidence: Expert opinion 9 12)

References

1 Piura E, Engel O, Doctory N, Markovitch O. The "full rectangle" sign: a novel method for ultrasonographic diagnosis of fetal aberrant right subclavian artery. Archives of gynecology and obstetrics 2025. link 2 Montero Carreras C, Cortés Olivera B, Saiz-Vivó R, Ferrer Menduiña Q, Garcia Martínez S, Rodríguez Pérez MA et al.. Aberrant right subclavian artery: the importance of distinguishing between isolated and non-isolated cases in prenatal diagnosis and clinical management. Journal of perinatal medicine 2025. link 3 Kordzadeh A, Mouhsen MI, Chan DM, Singh A, Gadhvi VM. Hybrid management of aberrant subclavian artery: A systematic review and meta-analysis. Vascular 2025. link 4 Matta R, Shah A, Bandesha H, Thiagarajasubramanian S, Muluk S. Case Report: Successful Treatment of Aberrant Left Subclavian Artery With a Right-Sided Aortic Arch. Vascular and endovascular surgery 2024. link 5 Spangler DJ, Eller RL. Left Subclavian Pseudoaneurysm: A Case of Palsies in the Recurrent Laryngeal Nerve, Phrenic Nerve, and Brachial Plexus. Ear, nose, & throat journal 2023. link 6 Loschi D, Santoro A, Rinaldi E, Bilman V, Chiesa R, Melissano G. A systematic review of open, hybrid, and endovascular repair of aberrant subclavian artery and Kommerell's diverticulum treatment. Journal of vascular surgery 2023. link 7 Fukuhara S, Ahmed Y, Shiomi S, Yang B, Kim KM, Deeb GM et al.. Aberrant Subclavian Arteries and Associated Kommerell Diverticulum: Endovascular vs Open Repair. The Annals of thoracic surgery 2022. link 8 Dong S, Alarhayem AQ, Meier G, Hardy DM, Lyden SP, Farivar BS. Contemporary management and natural history of aberrant right subclavian artery. Journal of vascular surgery 2022. link 9 Dueppers P, Floros N, Schelzig H, Wagenhäuser M, Duran M. Contemporary Surgical Management of Aberrant Right Subclavian Arteries (Arteria Lusoria). Annals of vascular surgery 2021. link 10 Varetto G, Castagno C, Trevisan A, Quaglino S, Garneri P, Mossetti C et al.. Mediastinoscopy-assisted Treatment of an Aberrant Right Subclavian Artery. Annals of vascular surgery 2016. link 11 Baker AC, Atkins BZ, Clouse WD, Noll R, Sampson J, Williams T. Repair of aberrant right subclavian artery entirely via a supraclavicular approach. Annals of vascular surgery 2014. link 12 Vucemilo I, Harlock JA, Qadura M, Guirgis M, Gowing RN, Tittley JG. Hybrid repair of symptomatic aberrant right subclavian artery and Kommerell's diverticulum. Annals of vascular surgery 2014. link 13 Karcaaltincaba M, Haliloglu M, Ozkan E, Kocak M, Akinci D, Ariyurek M. Non-invasive imaging of aberrant right subclavian artery pathologies and aberrant right vertebral artery. The British journal of radiology 2009. link 14 von Segesser L, Faidutti B. Symptomatic aberrant retro-esophageal subclavian artery: considerations about the surgical approach, management and results. The Thoracic and cardiovascular surgeon 1984. link 15 Hjelms E, Jacobsen E. Aberrant left pulmonary artery. Review of surgical results and report of a successfully treated case. Scandinavian journal of thoracic and cardiovascular surgery 1982. link 16 McIntyre MD, Lynn RB. Kommerell's diverticulum. Canadian journal of surgery. Journal canadien de chirurgie 1980. link

Compression of esophagus