Arteria Lusoria – Causes, Symptoms and Treatment
Arteria lusoria is a rare congenital vascular anomaly in which the right subclavian artery takes an abnormal course behind the esophagus, potentially causing swallowing difficulties.
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Arteria lusoria is a rare congenital vascular anomaly in which the right subclavian artery takes an abnormal course behind the esophagus, potentially causing swallowing difficulties.
What is Arteria Lusoria?
Arteria lusoria (Latin for "playful artery") is one of the most common congenital anomalies of the aortic arch. It occurs when the right subclavian artery does not arise in its usual position from the brachiocephalic trunk but instead originates directly from the aortic arch – typically as its last branch. The vessel then travels behind the esophagus (retroesophageal), or less commonly between the esophagus and the trachea. This vascular malformation affects approximately 0.5 to 2% of the population, making it the most frequently encountered aortic arch anomaly.
Causes and Development
Arteria lusoria arises during embryonic development due to a malformation of the aortic arch arteries. During normal fetal development, paired pharyngeal arch arteries develop into the major vessels of the thorax. An abnormal regression of the fourth right aortic arch leads to the atypical origin and course of the right subclavian artery. The condition is generally considered to have a genetic basis, and an association with certain chromosomal disorders – such as trisomy 21 (Down syndrome) – has been reported.
Symptoms
The majority of individuals with arteria lusoria are completely asymptomatic, and the anomaly is often discovered incidentally during imaging for other reasons. When symptoms do occur, they typically result from mechanical compression of adjacent structures:
- Dysphagia lusoria: Difficulty swallowing due to pressure on the esophagus – the most common symptom
- Chronic cough or throat irritation caused by pressure on the trachea
- Breathing difficulties or stridor (a high-pitched breathing sound)
- Chest pain or a sensation of pressure behind the sternum
- In rare cases: signs of vascular insufficiency in the right arm
Symptoms can occur at any age but often first appear in adulthood, when degenerative changes such as atherosclerosis cause stiffening of the vessel, increasing pressure on the esophagus.
Diagnosis
Arteria lusoria is frequently discovered as an incidental finding during imaging studies. The most important diagnostic methods include:
- CT Angiography (CTA): The gold standard for precise visualization of the aberrant vessel
- MR Angiography (MRA): A radiation-free alternative with excellent soft tissue detail
- Barium swallow (esophagram): May show a characteristic oblique indentation of the esophagus
- Endoscopy: May reveal a pulsating bulge in the esophageal wall
- Echocardiography: Limited utility, but may provide initial clues
Treatment
Asymptomatic arteria lusoria generally does not require treatment and is managed with periodic follow-up. For patients with significant symptoms, the following options are available:
Conservative Management
In mild cases, dietary adjustments (such as soft food and slow eating) and treatment of contributing conditions (such as atherosclerosis) may help relieve discomfort.
Surgical Treatment
In cases of severe or progressive symptoms, surgical intervention is indicated. Treatment options include:
- Vascular transposition: The aberrant artery is divided and reimplanted at an anatomically correct position – often connected to the brachiocephalic trunk or the ascending aorta
- Endovascular stent grafting: A minimally invasive option, particularly suitable for elderly or high-risk patients
- Hybrid procedures: A combination of open surgical and endovascular techniques
The prognosis following surgical treatment is generally excellent, with most patients experiencing complete resolution of swallowing difficulties.
References
- Kieffer E. et al. - Aberrant subclavian artery: Surgical treatment in thirty-three adult patients. Journal of Vascular Surgery, 1994.
- Polguj M. et al. - The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations. Folia Morphologica, 2014.
- Hanneman K. et al. - Congenital Variants and Anomalies of the Aortic Arch. RadioGraphics, 2017.
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