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Wadhokar P, Nalawade D, Jadhav A, Kadu R. Truncus bicarotics with arteria lusoria - A rare incidental finding with clinical implications. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_65_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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Sultan S, Acharya Y, Salahat H, Hynes N. Staged hybrid single lumen reconstruction (TIGER) with bilateral subclavian transposition coupled with thoracic endovascular aneurysm repair in the management of acute symptomatic complex type B aortic dissection in a patient with arteria lusoria. BMJ Case Rep 2021; 14:e244137. [PMID: 34433533 PMCID: PMC8388275 DOI: 10.1136/bcr-2021-244137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 12/16/2022] Open
Abstract
We present a 54-year-old Caucasian woman, who presented with acute symptomatic type B aortic dissection with deteriorating renal function. She was a known smoker with a 2-year history of dysphagia. CT angiography documented the artery of lusoria arising from the mid-thoracic aorta, aneurysmal dilation of her descending aorta, and kinetic and static flaps around her visceral ostia. The patient was managed by staged hybrid single lumen reconstruction and bilateral subclavian to carotid transpositions. During follow-up, there was no aortic rupture or retrograde type A dissection. There were no renal, visceral, cardiac, pulmonary or spinal complications. The patient went off her antihypertensive medication with a normal estimated glomerular filtration rate and accelerated aortic modulation.
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Affiliation(s)
- Sherif Sultan
- Vascular and Endovascular Surgery, National University of Ireland Galway, Galway, Ireland
| | - Yogesh Acharya
- Vascular and Endovascular Surgery, National University of Ireland Galway, Galway, Ireland
| | - Hiba Salahat
- Vascular and Endovascular Surgery, Western Vascular Institute, Galway, Ireland
| | - Niamh Hynes
- CÚRAM, National University of Ireland, Galway, Galway, Ireland
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Anomalous Right Subclavian Artery-Esophageal Fistulae. Case Rep Vasc Med 2018; 2018:7541904. [PMID: 29686924 PMCID: PMC5852896 DOI: 10.1155/2018/7541904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/01/2018] [Indexed: 01/27/2023] Open
Abstract
An aberrant right subclavian artery (ARSA) is the most common aortic arch anomaly, but only 19 previous cases of ARSA-esophageal fistula have been reported. Six patients have survived their bleeding episode. We describe the case of a 44-year-old woman who developed massive hemoptysis. Laryngoscopy, bronchoscopy, head and neck angiogram, and median sternotomy did not reveal what was presumed initially to be a tracheoinnominate fistula. Contrasted CT showed an anomalous subclavian artery posterior to the esophagus. Given the technical challenge of approaches for this pathology, the patient was unfit for open surgical repair. Therefore, endovascular covered stent grafts were deployed spanning the segment of the subclavian artery in continuity with the esophagus, via a right brachial artery approach. Unfortunately, the patient died after successful placement of the grafts.
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Ocaya A. Retroesophageal right subclavian artery: a case report and review of the literature. Afr Health Sci 2015; 15:1034-7. [PMID: 26957998 DOI: 10.4314/ahs.v15i3.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Variations of vessels arising from the aortic arch are numerous. One of the common anatomical variations is the right subclavian artery originating as the last branch of the aortic arch. This is a report of a case of an adult male cadaver with a retroesophageal right subclavian artery. OBJECTIVE To highlight the significance of a retroesophageal right subclavian artery, especially its clinical and surgical implications. METHOD Is a report of a case of an anomalous vessel found during routine student dissection of the chest region in a male cadaver. RESULT The retroesophageal subclavian artery was seen originating as the last branch from the postero-lateral aspect of the thoracic aorta at the vertebral level T4. The heart was normal with no other vascular variations seen in this region. CONCLUSION Anatomists and pathologists mainly encounter a retroesophageal right subclavian artery by chance and is usually described as asymptomatic, but several clinical conditions have been associated with its occurrence. This is a clear example of when knowledge of an anatomical variation is helpful in clinical practice.
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Affiliation(s)
- Anthony Ocaya
- Department of Anatomy, Faculty of Medicine, Gulu University, Gulu, Uganda
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Myers PO, Fasel JHD, Kalangos A, Gailloud P. Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects. Ann Cardiol Angeiol (Paris) 2009; 59:147-54. [PMID: 19962688 DOI: 10.1016/j.ancard.2009.07.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 07/15/2009] [Indexed: 11/26/2022]
Abstract
The left aortic arch with an aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occuring in 0.5-2.5% of individuals. Four vessels arise sequentially from the aortic arch: the right common carotid artery, the left common carotid artery, the left subclavian artery and the aberrant right subclavian artery, which crosses upwards and to the right in the posterior mediastinum. It results from a disruption in the complex remodelling of the paired branchial arches, typically of the right dorsal aorta distal to the sixth cervical intersegmental artery. The diagnosis and differentiation of arch anomalies is based on findings at chest radiography in association with those at esophagography. It is usually asymptomatic. When symptomatic, it produces dysphagia lusoria or dyspnea and chronic coughing. Treatment is indicated for symptomatic relief of dysphagia lusoria and for prevention of complications due to aneurysmal dilatation.
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Affiliation(s)
- P O Myers
- Division of Cardiovascular Surgery, Geneva University Hospital, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
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6
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Narita Y, Usui A, Ueda Y. Surgical treatment for thoracic aortic aneurysm with aberrant right subclavian artery. Gen Thorac Cardiovasc Surg 2006; 54:164-7. [PMID: 16642923 DOI: 10.1007/bf02662472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We present two operative cases of thoracic aortic aneurysm combined with aberrant right subclavian artery (ARSA). Case 1 was a 71-year-old man with a fusiform-type arch aneurysm. He underwent total aortic arch replacement to reconstruct all 4 arch branches. Case 2 was a 39-year-old man suffering from chronic DeBakey type IIIb dissection. He underwent total descending thoracic aortic replacement for the remaining ARSA. In both cases ARSA was diagnosed preoperatively by reconstructed three-dimensional computed tomography (3D-CT). Both patients followed uneventful postoperative courses with excellent results. 3D-CT is helpful for precise planning of surgical strategy in such cases.
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Affiliation(s)
- Yuji Narita
- Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Waltham M, Agrawal V, Bowman L, Hughes C, White GH. Right Arm Ischemia Following Intentional Stent-Graft Coverage of an Anomalous Right Subclavian Artery. J Endovasc Ther 2005; 12:110-4. [PMID: 15701041 DOI: 10.1583/04-1374r.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report thoracic aortic stent-graft repair in a patient with abnormal aortic arch anatomy. CASE REPORT An anomalous right subclavian artery was covered with a stent-graft in a 38-year-old woman being treated for a false aneurysm after coarctation repair. The right arm became relatively ischemic, but was viable and managed conservatively. CONCLUSIONS Aneurysms close to left or aberrant right subclavian arteries can be safely and effectively treated by endoluminal repair without the need for revascularization procedures; ischemic symptoms that develop are often mild and transient.
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Affiliation(s)
- Matthew Waltham
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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Yanik B, Conkbayir I, Keyik B, Hekimoglu B. A rare anomalous origin of right vertebral artery: findings on Doppler sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:211-214. [PMID: 15101084 DOI: 10.1002/jcu.20013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Anomalous origin of the right vertebral artery from the right common carotid artery occurs rarely. To the best of our knowledge, the medical literature contains no information about gray-scale and Doppler sonography findings in this anomaly, despite the extensive information available from angiographic studies and postmortem examinations. We present the case of a 32-year-old man who suffered from a sudden onset of hemiparesis on the left side. Doppler sonography revealed a partial thrombosis in the proximal part of right common carotid artery. The right vertebral artery was shown to originate from the proximal part of the right common carotid artery. The right vertebral artery was patent. Thus, the use of color Doppler sonography can aid in the diagnosis of some vascular anomalies.
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Affiliation(s)
- Bahar Yanik
- Department of Radiology, Social Security Ankara Hospital, TR-06110 Dişkapi, Ankara, Turkey
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9
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Feugier P, Lemoine L, Gruner L, Bertin-Maghit M, Rousselet B, Chevalier JM. Arterioesophageal fistula: a rare complication of retroesophageal subclavian arteries. Ann Vasc Surg 2003; 17:302-5. [PMID: 12704542 DOI: 10.1007/s10016-001-0406-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Formation of a fistula between a retroesophageal subclavian artery and the esophagus is a rare cause of hematemesis that is usually fatal. Several etiologies have been described. The purpose of this report is to describe a case involving successful surgical repair of an arterioesophageal fistula induced by prolonged nasogastric intubation. A preoperative CT scan under emergency conditions allowed tentative diagnosis. Arteriography in the operating room confirmed the presence of a fistula and also allowed temporary hemostasis by tamponade. On the basis of a review of the literature, this case demonstrates the importance of screening patients requiring prolonged nasogastric intubation to rule out the possibility of an aberrant aortic arch system.
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Affiliation(s)
- Patrick Feugier
- Service de Chirurgie Vasculaire, Hôpital Edouard Herriot, Lyon, France.
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10
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Boas N, Desmoucelle F, Bernadet V, Franceschi JC. Rare cause of acute ischemia of the right upper extremity: thrombosis of a retroesophageal subclavian artery. Ann Vasc Surg 2002; 16:387-90. [PMID: 12016541 DOI: 10.1007/s10016-001-0232-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Thrombosis of a subclavian artery is an uncommon cause of acute upper extremity ischemia in the elderly. Malformations of the aortic arch system are also rare. The purpose of this report is to describe an unusual case involving acute ischemia of the right upper extremity due to extensive thrombosis of a retroesophageal right subclavian artery (RSA) in a 79-year-old woman. Despite delayed diagnosis of the underlying etiology, the patient was successfully treated by extensive thrombectomy of the arteries in the upper extremity and right subclavian-to-carotid artery transposition.
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Affiliation(s)
- Norbert Boas
- Service de Chirurgie Vasculaire, Polyclinique I'Espérance, Albi, France
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Abstract
Dysphagia lusoria is described in the literature as difficulty swallowing because of a "jest of nature." The "jest of nature" is a birth defect encompassing any aortic root vascular anomaly that causes esophageal dysphagia. Persons with dysphagia lusoria can be categorized according to their specific subclavian anomaly (ie, depending on the presence of an aneurysm, occlusive disease, or esophageal compression). All patients with this anomaly have an aberrant subclavian artery in a transposed position that courses posterior to the esophagus. The operative approach to repair this condition has been controversial. An extrathoracic approach is documented as superior to a repair involving thoracotomy because there is decreased rate of complications that may be associated with a thoracotomy and greater visibility of the subclavian and carotid artery. This case study describes a 25-year-old woman with dysphagia lusoria related to an aberrant right subclavian artery. The report includes a literature review and describes the perioperative approach and nursing care. The use of the preadmission and same-day admission services are supported as is an extrathoracic surgical approach. At follow-up this patient reported no symptoms of dysphagia and showed no evidence of esophageal compression confirming that persons with symptomatic dysphagia lusoria can be managed with positive long-term results.
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Affiliation(s)
- A Whitley
- London Health Sciences Centre, Division of Vascular Surgery, London, Ontario, Canada
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12
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Abstract
We describe a patient who sustained a traumatic rupture of an aberrant right subclavian artery. An interposition graft was used to restore continuity of the artery to the descending thoracic aorta.
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Affiliation(s)
- J J Alcocer
- Division of Cardiothoracic Surgery, University of Massachusetts Medical Center, Worcester 01655-0304, USA
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Krinsky G, Rofsky NM. MR ANGIOGRAPHY OF THE AORTIC ARCH VESSELS AND UPPER EXTREMITIES. Magn Reson Imaging Clin N Am 1998. [DOI: 10.1016/s1064-9689(21)00462-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Miller RG, Robie DK, Davis SL, Cooley DA, Klish WJ, Skolkin MD, Kearney DL, Jaksic T. Survival after aberrant right subclavian artery-esophageal fistula: case report and literature review. J Vasc Surg 1996; 24:271-5. [PMID: 8752039 DOI: 10.1016/s0741-5214(96)70103-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Development of a fistula between an aberrant right subclavian artery and the esophagus is a rare cause of heretofore fatal hematemesis. We report the first known survivor of this devastating complication of the most common aortic arch anomaly. Intraoperative esophagogastroduodenoscopy, intraesophageal balloon tamponade, and arteriography were the keys to successful management. This lesion should be suspected in the setting of bright red, "arterial" hematemesis. Prolonged nasogastric and/or endotracheal intubation should be avoided in patients with a known aberrant right subclavian artery or other aortic arch anomaly.
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Affiliation(s)
- R G Miller
- Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Chambers JL, Neale ML, Appleberg M. Fibromuscular hyperplasia in an aberrant subclavian artery and neurogenic thoracic outlet syndrome: an unusual combination. J Vasc Surg 1994; 20:834-8. [PMID: 7966820 DOI: 10.1016/s0741-5214(94)70173-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
An aberrant right subclavian artery arising distal to the origin of the left subclavian artery is the most common anomaly of the aortic arch. Degenerative diseases of aberrant subclavian arteries including aneurysms and occlusive disease have been reported previously. We believe that this case is the first reported case of fibromuscular hyperplasia affecting an aberrant subclavian artery. A 25-year-old woman admitted with a history consistent with neurogenic thoracic outlet syndrome was found to have a reduced pulse and blood pressure on the ipsilateral side caused by fibromuscular hyperplasia of an aberrant subclavian artery. A carotid-subclavian bypass via a supraclavicular incision was performed at the same time as thoracic outlet decompression. Histologic examination confirmed the presence of fibromuscular hyperplasia in the aberrant subclavian artery. This case is discussed with reference to the available literature.
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Affiliation(s)
- J L Chambers
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Cave EM, Virdi IS, Ruttley MS. Case report: an unusual case of the superior vena cava syndrome--aneurysm of an aberrant right subclavian artery. Clin Radiol 1994; 49:834-7. [PMID: 7955856 DOI: 10.1016/s0009-9260(05)81979-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of aberrant right subclavian artery (RSA) aneurysm presenting solely with symptoms and signs of superior vena cava obstruction (the SVC syndrome) is described. The SVC syndrome is usually a consequence of mediastinal malignancy and only rarely due to compression by an arterial aneurysm.
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Affiliation(s)
- E M Cave
- Department of Radiology, University Hospital of Wales, Cardiff
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Kieffer E, Bahnini A, Koskas F. Aberrant subclavian artery: surgical treatment in thirty-three adult patients. J Vasc Surg 1994; 19:100-9; discussion 110-1. [PMID: 8301723 DOI: 10.1016/s0741-5214(94)70125-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Because of the scarcity of large series in the literature, our experience with surgery for aberrant subclavian arteries (aSA) in adults was reviewed. METHODS During the last 16 years we have surgically treated 33 adult patients with aSA. Twenty-eight patients had a left-sided aortic arch with a right aSA whereas five had a right-sided aortic arch with a left aSA. Eleven patients (group 1) had dysphagia caused by esophageal compression by a nonaneurysmal aSA; five patients (group 2) had ischemic symptoms caused by occlusive disease of a nonaneurysmal aSA; 10 patients (group 3) had aneurysms of the aSA with or without symptoms caused by esophageal compression or arterial thromboembolism; and seven patients (group 4) had an aSA arising from a diseased (usually aneurysmal) thoracic aorta. In all cases the divided aSA was revascularized, most often by direct transposition into the ipsilateral common carotid artery. Nine of the 16 patients in groups 1 and 2 underwent operation with a cervical approach alone. In the remaining seven, the cervical approach was combined with a median sternotomy (six cases) or a left thoracotomy (one case). In the 17 patients in groups 3 and 4, either a cervical approach (two cases), a median sternotomy (four cases), or a two-staged approach combining a supraclavicular incision on the side of the aSA with a posterolateral thoracotomy on the side of the aortic arch (11 cases) was used. Aortic cross-clamping was required in 12 of these patients to perform the transaortic closure of the origin of the aSA with patch angioplasty (three cases), or prosthetic replacement of the descending thoracic aorta (nine cases). Cardiopulmonary bypass was used in six patients (including three with hypothermic circulatory arrest). RESULTS Four patients, all in groups 3 and 4, died after operation: two of multiorgan failure, one of heart failure, and one of esophageal rupture. Satisfactory clinical and anatomic results were obtained in the remaining 29 patients. CONCLUSIONS The surgical approach to aSA must be flexible and adapted to the anatomic conditions found. We recommend routine reconstruction of the aSA to avoid ischemic complications in the vertebrobasilar territory or upper extremity. Provision should be made for cardiopulmonary bypass in patients with aneurysm of aSA or associated aortic aneurysm.
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Affiliation(s)
- E Kieffer
- Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
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Mandalam KR, Rao VR, Gupta AK, Joseph S, Unni NM, Rao AS. Occlusion of an aberrant right subclavian artery arising from a Kommerel diverticulum. J Vasc Interv Radiol 1993; 4:577-9. [PMID: 8353359 DOI: 10.1016/s1051-0443(93)71926-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- K R Mandalam
- Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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