BACKGROUND: The aberrant right subclavian artery (ARSA) is the most common anomaly of the arch of aorta and is significantly associated with a non-recurrent laryngeal nerve (NRLN). Nevertheless, the co-occurrence of ARSA with complex thoracic wall vascular remodeling is scarcely described in the current literature. This exploration describes an unusual group of neurovascular variations with important surgical significance. CASE PRESENTATION: A precise dissection was performed on a 43-year-old female donor of Thai descent embalmed with soft-embalming technique with vascular silicone-color injection. The cervical and upper thoracic regions were dissected with emphasis on neurovascular pattern, and morphometric measurements. A retroesophageal ARSA was found to be the fourth branch of the aortic arch after the left subclavian artery, without a Kommerell diverticulum. A right-sided NRLN was confirmed to arise directly from the vagus nerve to then travel upwards next to the larynx. Crucially, the right internal thoracic artery (ITA) was completely absent, and its usual vascular territory was replaced by the superior intercostal artery (SIA) arising from the inferior aspect of the ARSA. Moreover, a separate muscular branch of the proximal ARSA was observed to provide blood supply to the left longus colli muscle. CONCLUSION: The current report describes a novel association of ARSA, NRLN, complete absence of the right ITA with a compensatory SIA and a muscular branch from the ARSA to the left longus colli muscle. This research emphasizes the embryological connection of the development of the cervical and thoracic vessels and indicates that thorough preoperative imaging is required to prevent any iatrogenic injury during surgery of the thyroid gland, cervical spine, esophagus and coronary bypass surgeries.
Prommahom et al. (Tue,) studied this question.