Aberrant Right Subclavian Artery and Cardiac Surgery: Anesthetic and Surgical Implications

The aberrant right subclavian artery (ARSA) or arteria lusoria, is one of the most common anomalies of the aortic arch, with a reported incidence of about 0.5-1.8%. Most patients with aberrant right subclavian artery are often asymptomatic. About 10% patients with a retroesophageal course of the ARSA may exhibit tracheoesophageal symptoms. Radiographic diagnosis of this condition can be made by chest X-ray, fluoroscopy, computed tomography scan, or magnetic resonance imaging. During procedures involving the trachea or esophagus, there is a risk of iatrogenic damage to the vessel or surrounding tissues, which could result in fistula formation or gastroesophageal complications such as excessive gastrointestinal bleeding. During cardiac surgery, the presence of ARSA causing near complete compression of the esophagus can result in the inability to insert a transesophageal echocardiography probe.