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Aberrant subclavian artery causing difficulty in transhiatal esophageal dissection
C S Pramesh1, A P Saklani, V Parmar
1Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Summary
An aberrant right subclavian artery, a rare developmental anomaly, complicated esophageal cancer surgery. This case highlights surgical challenges and the need for awareness of vascular variations.
Area of Science:
- Vascular anatomy and embryology
- Surgical oncology
- Gastrointestinal surgery
Background:
- The right subclavian artery typically originates from the brachiocephalic artery.
- Developmental anomalies of the subclavian artery can present surgical challenges.
- Esophageal carcinoma requires complex surgical management, often involving esophagectomy.
Observation:
- A patient with esophageal carcinoma presented with an aberrant right subclavian artery.
- This vascular anomaly posed significant difficulties during a planned transhiatal esophagectomy.
- The surgical approach had to be converted to a transthoracic procedure due to the anomaly.
Findings:
- Aberrant right subclavian artery (ARSA) is a rare congenital anomaly.
- ARSA can lead to unexpected intraoperative complications during thoracic and neck surgeries.
- Successful management required adapting the surgical strategy to the patient's unique anatomy.
Implications:
- Awareness of ARSA is crucial for surgeons performing esophageal surgery.
- Preoperative imaging may help identify such anomalies, though they can be missed.
- Understanding embryologic origins aids in predicting and managing vascular variations in clinical practice.