Arteria Lusoria

Arteria Lusoria

Arteria lusoria refers to an aberrant right subclavian artery (ARSA)—the most common congenital anomaly of the aortic arch.

1️⃣ Definition

It is a vascular anomaly in which the right subclavian artery arises as the last branch of the aortic arch, instead of from the brachiocephalic trunk, and typically courses posterior to the esophagus to reach the right upper limb.

2️⃣ Embryology

Normal development:

• Right 4th aortic arch → proximal right subclavian artery
• Right dorsal aorta regresses distally

In arteria lusoria:

• The right 4th arch regresses abnormally
• The right dorsal aorta persists
• Result → right subclavian arises distal to left subclavian

3️⃣ Anatomy

Normal aortic arch branches:

1. Brachiocephalic trunk
2. Left common carotid
3. Left subclavian

In arteria lusoria:

1. Left common carotid
2. Left subclavian
3. Aberrant right subclavian artery (last branch)

Course:

• 80% → posterior to esophagus
• 15% → between esophagus and trachea
• 5% → anterior to trachea

4️⃣ Clinical Significance

🔹 Dysphagia Lusoria

Compression of esophagus → progressive dysphagia
Term coined in 1794 by David Bayford

🔹 Respiratory symptoms (rare)

Stridor, cough (especially in infants)

🔹 Aneurysmal dilation

May form a Kommerell diverticulum

5️⃣ Associated Conditions

• Down syndrome
• DiGeorge syndrome
• Congenital heart disease

6️⃣ Diagnosis

Gold standard:

• CT angiography

Other modalities:

• Barium swallow → posterior indentation
• MRI angiography
• Doppler ultrasound

7️⃣ Management

Asymptomatic → Observation

Symptomatic:

• Surgical reimplantation to right carotid
• Endovascular repair if aneurysmal

8️⃣ Exam Pearls (NEET-SS / Superspeciality)

• Most common aortic arch anomaly
• Causes dysphagia without intrinsic esophageal disease
• Think of it in elderly patient with progressive dysphagia and normal endoscopy
• May be associated with Kommerell diverticulum aneurysm