Combined treatment of dysphagia lusoria and concomitant ipsilateral carotid artery stenosis

Abstract

Introduction: The aberrant subclavian artery is the most common variation of the aortic arch but symptoms of dysphagia lusoria appear only in 0,5-2 % of the patients. There is no consensus on its treatment. Case report: We hereby present the case of an 86 year-old woman who had suffered dysphonia and dysphagia for 1.5-2 years associating a loss of 10 kg of weight in the last 6 months. An angioCT scan revealed a non-dilated aberrant right subclavian artery which compressed of the retrocardial esophagus, and a 60 % stenosis of the right carotid artery, which had caused an ipsilateral minor stroke 5 months before. We performed a right carotid-subclavian bypass using a 6 mm ePTFE graft, followed by a right carotid endarterectomy and Dacron patch angioplasty in the same procedure. The postoperative period was uneventful, the patient remained asymptomatic, with no neurological symptoms, dysphagia or dysphonia, and resumed normal oral intake. Ten days after the procedure the control CT revealed a thrombosed right subclavian artery with no residual esophageal compression, so an additional endovascular occlusion of the subclavian origin was deemed unnecessary. Discussion: Although we first considered the possibility of performing a sequential hybrid treatment, with initial surgical bypass and secondary thoracic endovascular grafting, the combined open surgical technique allowed us to solve both the dysphagia lusoria and the symptomatic right carotid stenosis in one single procedure, and the complementary thoracic endografting was ultimately unnecessary.