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Aberrant Subclavian Artery
Tuesday, 16 November 2004
Tuesday, 16 November 2004

What

The diagnosis of an aberrant subclavian artery indicates the finding of an abnormal location of one of the subclavian arteries. The arteries are a system of blood vessels that start as large vessels, originating from the heart, that then branch off to smaller and smaller blood vessels to supply blood to the entire body. There are two subclavian arteries; one on the left and one on the right. Normally, the right subclavian artery arises from another artery, named the innominate artery, and is usually found where the sternum (breastbone) and the clavicle (collar bone) meet. Occasionally, however, the right subclavian artery can branch off of the left aortic arch. When this happens, the right subclavian artery runs behind the esophagus, occasionally compressing it. When the artery puts pressure on the esophagus it can cause problems with swallowing. In comparison, the left subclavian artery usually arises from the arch of the aorta at a very specific point. When the left subclavian artery branches off from an atypical location on the aorta, an aortic diverticulum (pouch-like enlargement) at the site of attachment can occur (diverticulum of Kommerell). When this happens a ring of blood vessels can surround the esophagus. Like the aberrant right subclavian artery, the aberrant left subclavian artery also runs behind the esophagus and pushes it towards the sternum (towards the front). The resulting compression is usually more severe and can also lead to compression of the airway. Aberrant subclavian arteries (especially the one on the right) are associated with congenital heart disease and various syndromes, such as Dubowitz’s, Velo-Cardio-Facial, Down’s, DiGeorge, Edwards syndromes as well as Tetralogy of Fallot and coarctation of the aorta.

Who

Aberrant right subclavian artery is the most common blood vessel malformation present at birth and involves the aortic arch. It can be found in 1 out of every 200 births (0.5% of the population).

Signs and Symptoms

The vast majority of infants born with an aberrant subclavian artery will experience no symptoms. Many people discover that they have this atypical anatomy by coincidence, when the blood vessels are being evaluated for another reason. When symptoms do occur, increased activity level can worsen the severity of the symptoms. Symptoms associated with vascular compression by an aberrant RIGHT subclavian artery are: 1. Dysphagia Lusoria: swallowing difficulties because of compression of the esophagus 2. Dyspnea (shortness of breath) because of compression of the trachea (airway) 3. Bleeding from arterio-esophageal fistula (abnormal connection point) 4. Thrombosis (blood clot formation) and central venous compression 5. Aneurism rupture, including sudden symptoms of shortness of breath and reduced blood supply to upper extremity Symptoms associated with vascular compression by an aberrant LEFT subclavian artery are: 1. Compression of the esophagus, leading to swallowing difficulties and obstruction 2. Respiratory difficulties

Possible Causes

The causes of this atypical vascular formation are not known.

Diagnosis

The diagnosis can be made by various imaging modalities, including CT and MRI. It is also possible to gain some knowledge of the anatomy by doing X-rays with barium swallow studies. Studies of the blood vessels, aortic arch angiography and venography, can allow the physician to assess the relative anatomy of the vessels involved and to look for the presence of dilation to the blood vessels.

Treatment

The vast majority of people with aberrant subclavian arteries do not have symptoms and do not require any treatment. Mild symptoms of esophageal compression may respond to diet modifications, such as eating soft foods in small amounts. More severe esophageal symptoms, symptoms of respiratory compression or presence of a thrombus or an aneurism may require surgical intervention.

Prognosis

Many people live a full life without being aware of an atypical blood vessel formation. Good treatments are available for those that become symptomatic and upon the correction of their problem; they can go on to live a healthy life. The prognosis may be different, however, if an aberrant subclavian artery is one of the many findings in a patient with a specific syndrome or congenital heart defect.

Connect with other parents

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Weblinks

Amersham Health
This website contains an article on aberrant subclavian artery which includes an X-ray; however the text is very technical in medical terminology.

American Venous Forum
This link goes to a case presentation of Central Venous Compression and Thrombosis from Aberrant Subclavian Artery in a question and answer format. It is technical but the treatment section is quite extensive.

Google Search for Aberrant Subclavian Artery

References and Sources

Goldman: Cecil Textbook of Medicine, 21st ed. W.B. Saunders Company, 2000. www.home.mdconsult.com/das/book/39872360-2/view/882?sid=290737895