2018 Volume 43 Issue 6 Pages 1021-1026
Aberrant Right Subclavian Artery (ARSA) is relatively rare, and anatomical abnormalities of the right recurrent laryngeal nerve and thoracic duct often coexist with this condition. Because ARSA is located behind the esopagus, it is difficult to dissect the left upper mediastinal lymph node. In most of cases with ARSA, the right recurrent laryngeal nerve is not recurrent and the thoracic duct runs in the right thoracic cavity, increasing the probability of damage to the right recurrent laryngeal nerve and thoracic duct. Particular care is required during esophagectomy in patients with ARSA.
The patient was a 55-year-old woman who had undergone endoscopic submucosal dissection (ESD) for thoracic esophageal carcinoma. Surgical esophagectomy was needed in addition, because examination of the ESD specimen revealed vascular invasion. Preoperative CT revealed the ARSA. Thoracoscope-assisted subtotal esophagectomy was performed by cutting the esophagus at the upper side, with reconstruction using a gastric conduit via a retrosternal approach. The patient was discharged without any perioperative complications, and the long-term swallowing difficulty that the patient had suffered from resolved after the operation.
