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Bleeding from an aberrant right subclavian artery (case report)

Abstract

Background. The aberrant right subclavian artery (arteria lusoria) is the most common anomaly of aortic arch vessels. A rare but potentially life-threatening complication of this anomaly is the formation of an arterioesophageal fistula with the development of hemorrhage. Due to rarity of the disease, no unified therapeutic and diagnostic algorithm has been worked out as yet.

Objective. The purpose of this article is to demonstrate the present-day possibilities of diagnosis and treatment of developing hemorrhage from a fistula formed between the aberrant right subclavian artery and esophagus.

Patients and methods. We retrospectively analyzed the case history of a 6-year-old girl after endured acute cerebral ischemia. During 107 days, she was on artificial pulmonary ventilation and and fed through a nasogastric tube, which resulted in formation of a fistula between the aberrant subclavian artery and esophagus, complicated by profuse bleeding.

Results and discussion. In patients with the aberrant right subclavian artery, long-term tube feeding may contribute to formation of an arterioesophagel fistula with the development of profuse hemorrhage. In this clinical case, endoscopic methods of hemostasis turned out to be ineffective. Bleeding was temporarily stopped using the Sengstaken-Blackmore tube. The girl underwent occlusion of the fistula by means of implantation of endovascular stents and endoscopic clipping of the defect in the esophagus.

Conclusion. Prolonged tube feeding and tracheostomy can cause the formation of an arterioesophagel fistula complicated by profuse bleeding which should temporarily be stopped using the Sengstaken-Blackmore tube. A combination of roentgen-endovascular methods of treatment and endoscopic techniques may be a possible variant of treating patients with this pathology.

Keywords:arteria lusoria; aberrant right subclavian artery; vascular anomalies; arterioesophagel fistula fistula; bleeding

Funding. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Ilkanich A.Ya., Darvin V.V., Satinov A.V., Ryzhikov M.G., Oganyan A.V.; data collection and handling – Ryzhikov M.G., Oganyan A.V.; draft manuscript preparation – Ilkanich A.Ya., Darvin V.V., Ryzhikov M.G., Oganyan A.V.; manuscript revision – Ilkanich A.Ya., Darvin V.V., Ryzhikov M.G., Oganyan A.V.

For citation: Ilkanich A.Ya., Darvin V.V., Satinov A.V., Ryzhikov M.G., Oganyan A.V. Bleeding from an aberrant right subclavian artery (case report). Angiology and Vascular Surgery. 2023; 29 (1): 131–5. DOI: https://doi.org/10.33029/1027-6661-2023-29-1-131-135 (in Russian)

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Akchurin Renat Suleymanovich

Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, Deputy General Director for Surgery, Head of the Department of Cardiovascular Surgery, National Medical Research Center for Cardiology named after Academician E.I. Chazov, President of the Russian Society of Angiologists and Vascular Surgeons

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.