The value of preoperative diagnosis of aberrant right subclavian artery in surgery of parathyroid glands: the clinical observation

Abstract

Aberrant right subclavian artery (arteria lusoria) is abnormal development of the aortic arch and its branches, which is often associated with the right non-recurrent laryngeal nerve. The presence of such anatomy increases the risk of intraoperative damage to the laryngeal nerve to 12.9% (in the classic version, the risk is 1-2%). The aim of this article is to show the clinical observation of the preoperative diagnosis of arteria lusoria when planning surgical treatment to patients with benign parathyroid disease. The clinical case presents a 53-year-old male patient with primary hyperparathyroidism. While the additional preoperative examination (MRI) was being conducted to reveal the localization of parathyroid adenoma and to exclude multiple disease of the parathyroid glands, the aberrant right subclavian artery was detected. To clarify vascular architectonics of the branches of the aortic arch, the multispiral computed (MSCT) angiography of brachycephalic arteries was performed. The study showed that the first branch of the aortic arch is the common mouth of the carotid arteries, the second one is the left subclavian artery and the third branch is the right subclavian artery (type H according to the Adachi – William’s classification). The latter goes from the left to the right in the oblique-lateral direction behind the esophagus, deforming its lumen along the posterior wall. The vascular anomaly was an accidental find that played a significant role in planning the operation. As a result of the preoperative assessment of the patient's anatomical features, the intraoperative trauma and the search time for the non-recurrent laryngeal nerve and parathyroid adenoma were minimal. We consider it is necessary to use all possible methods for imaging the parathyroid glands, including MSCT angiography, MRI in order to exclude the possibility of multiple disease when planning surgical intervention for patients with primary hyperparathyroidism. In this clinical case, this approach made it possible to diagnose the aberrant right subclavian artery in the preoperative period and associate with the non-recurrent right laryngeal nerve.