An aberrant right subclavian artery (ARSA) represents a congenital variation in the typical arrangement of blood vessels branching from the aorta. While many individuals with this anatomical difference experience no health concerns, it can sometimes lead to noticeable symptoms. Understanding ARSA helps recognize its potential physical manifestations. This article explores the common symptoms associated with an aberrant right subclavian artery.
Understanding Aberrant Right Subclavian Artery
An aberrant right subclavian artery is the most frequently occurring congenital anomaly of the aortic arch. In typical anatomy, the right subclavian artery branches directly from the brachiocephalic artery. However, with an ARSA, this vessel originates as the last branch from the left side of the aortic arch, after the left subclavian artery.
From its unusual origin, the aberrant right subclavian artery then crosses behind the esophagus to reach the right arm. This anatomical deviation means the artery takes a longer, more circuitous path compared to its usual course. This variation is relatively uncommon, affecting approximately 0.5% to 1.8% of the general population.
Recognizing Common Symptoms
Symptoms associated with an aberrant right subclavian artery arise when the vessel compresses nearby structures, primarily the esophagus or trachea. The presentation of these symptoms varies significantly, often depending on the individual’s age and the degree of compression. Many individuals with an ARSA remain without symptoms throughout their lives.
In infants and young children, ARSA can sometimes lead to respiratory difficulties and feeding problems. Respiratory symptoms may include stridor, a high-pitched sound during breathing, or recurrent respiratory infections and wheezing. These issues often stem from the aberrant artery pressing on the trachea, narrowing the airway.
Feeding difficulties in infants can manifest as choking episodes, slow feeding, or recurrent vomiting after meals. This happens when the artery compresses the esophagus, making it challenging for food to pass through.
Adults with an aberrant right subclavian artery are most likely to experience dysphagia lusoria, which is difficulty swallowing. This symptom involves solid foods more than liquids and develops gradually over time. The persistent pressure of the artery on the esophagus can cause discomfort or a sensation of food getting stuck.
Less commonly, adults might report other symptoms such as non-specific chest pain, a persistent cough, or shortness of breath. These symptoms are often mild and can be easily attributed to other conditions, making diagnosis challenging. The severity of symptoms can range from barely noticeable to significantly impacting daily life.
Diagnosis and Management
When symptoms suggest the presence of an aberrant right subclavian artery, medical professionals employ specific diagnostic imaging techniques. A barium swallow study can reveal an indentation on the posterior wall of the esophagus, indicating external compression. More detailed imaging, such as computed tomography (CT) angiography or magnetic resonance imaging (MRI), provides precise anatomical visualization of the aberrant vessel and its relationship to surrounding structures.
The approach to managing an aberrant right subclavian artery depends on whether symptoms are present and their severity. For individuals who are asymptomatic, no intervention is necessary, and observation is the standard approach. Regular monitoring may be recommended to detect any symptom development.
If symptoms are bothersome and clearly linked to the ARSA, various interventions can be considered. For mild dysphagia, dietary modifications, such as eating smaller, more frequent meals or consuming softer foods, may provide relief. In severe cases, especially those with significant respiratory distress or persistent, debilitating swallowing difficulties, surgical correction may be an option. This procedure involves repositioning or dividing the aberrant artery to relieve pressure on the trachea and esophagus.