2 articles
Dysphagia lusoria refers to dysphagia caused by an aberrant right subclavian artery (ARSA), a rare congenital anomaly of the aortic arch. This article presents a clinical case of symptomatic ARSA, accompanied by a comprehensive review of its anatomical, clinical, and therapeutic aspects.
We present the case of a 54-year-old female patient diagnosed with dysphagia lusoria due to ARSA, who underwent surgical intervention after clinical and imaging evaluations. The literature was reviewed through PubMed using the keywords: “aberrant right subclavian artery”, “dysphagia lusoria”, and “arteria lusoria”.
The patient presented with progressive dysphagia, morning cough, fatigue, and weight loss. Imaging revealed ARSA compressing the esophagus, and the presence of a bicarotid trunk. Surgical correction involved right subclavian-to-carotid transposition, with complete resolution of symptoms. The literature review showed a modest grade of evidence regarding the management of patients with dysphagia lusoria, mostly including case reports and limited case series. Treatment is usually indicated in symptomatic patients, with options including open surgery or hybrid approaches.
ARSA can cause significant esophageal symptoms in adults, representing a diagnostic challenge. Appropriate imaging and timely surgical intervention are crucial in symptomatic cases. Awareness of aortic anatomical variants is essential for both diagnosis and treatment planning.
Open balloon thrombectomy and embolectomy remain the preferred initial option in the management of acute lower limb ischemia (ALI), but various endovascular techniques have become accessible and are growing in popularity. The aim of the study was to assess our early experience with percutaneous vacuum-assisted thromboaspiration using the Penumbra/Indigo® system for non-traumatic ALI.
The study group comprised 13 patients with ALI who received treatment between September 2022 and June 2023; with 7 (53.8%) being males. The median age was 71 years (25%-75%IQR 62.5-77.5). ALI cases were classified according to the Rutherford scale: grade I – 2 (15.3%), grade IIA – 7 (53.8%), and grade IIB – 4 (30.7%). In 10 (76.9%) cases, ischemia was classified as "acute-on-chronic." The occluded native vascular segment, determined through preoperative computer tomography angiography (n=4; 30.7%), duplex scanning (n=5; 38.4%), or both examinations (n=4; 30.7%), were as follows: superficial femoral artery (n=7) and popliteal artery (n=2). In two patients, thrombosis of the below-knee femoropopliteal bypass with autogenous vein was identified, while two others presented with femoral artery stent thrombosis. An embolic etiology of ALI was observed in 4 (30.7%) cases, and thrombotic etiologyin 9 (69.2%) cases. Endovascular access was established via the ipsilateral common femoral artery (n=10), crossover (n=2), or brachial artery (n=1). Thromboaspiration was carried out using dedicated CAT6™ and CAT8™ catheters.
The technical success rate of vacuum-assisted thromboaspiration was 92.3%. Subsequent angiography revealed accompanying occlusive-stenotic lesions in all instances, necessitating transluminal angioplasty, and in 8 (61.5%) patients, additional stenting was required. Catheter-directed thrombolysis was utilized as an adjunct in one patient. There were 2 (15.3%) instances of distal embolization, both addressed within the same surgical session. Survival and limb salvage rates at the 30th-day follow-up stood at 100%.
Utilizing the Penumbra/Indigo® system, percutaneous vacuum-assisted thromboaspiration appears to be a safe and effective minimally invasive technique for treating ALI. This method allows for the concurrent correction of coexisting chronic peripheral arterial lesions.