The aberrant right subclavian artery and non-recurrent laryngeal nerve: a cadaveric study

The aberrant right subclavian artery (ARSA), or arteria lusoria, is an aortic arch variant in which the right subclavian artery arises distal to the left subclavian artery and typically follows a retroesophageal course. Although often asymptomatic, ARSA can present with clinical symptoms and complicate surgical procedures, particularly when associated with other anatomical variants such as a non-recurrent laryngeal nerve (non-RLN).

During routine dissection of a donated cadaver, variations in the aortic arch and laryngeal nerves were identified. Arterial dimensions and branching relationships were measured using a string, hemostats, and calipers.

We present a cadaveric case of a 74-year-old African American male with a retroesophageal ARSA and a right non-RLN. Our group's dissection revealed the absence of a brachiocephalic trunk, with the right common carotid artery originating directly from the arch of the aorta. The ARSA arose as the fourth branch of the arch and measured 46 mm in circumference and 19.15 mm in width at its origin. Additionally, the non-RLN branched from the cervical vagus nerve and traveled directly to the larynx, consistent with a Type I course.

This case highlights the embryological link between vascular and neural development and underscores the clinical importance of identifying such variants preoperatively to avoid complications during head, neck, and thoracic surgery.