Main Article Content
Background. The aberrant right subclavian artery (lat. arteria lusoria, AL) is a rare vascular abnormality of the aortic arch in humans, which occurs with a frequency of 0.1–2.5 % and is of great clinical importance due to the associated abnormality of the lower laryngeal nerve (non-recurrent laryngeal nerve, NLN), the risk of damage to which during thyroid surgery increases dramatically. For the first time in Ukraine, the clinical case of preoperative diagnosis of AL, intraoperative identification of NLN is comprehensively described and the current state of the issue is analyzed. The purpose was to show the importance of studying the aortic arch anatomy with a possible presence of AL, which in turn causes abnormal embryonic formation of NLN with a high risk of its damage during thyroid surgery, based on the case history of a treated female patient with papillary thyroid cancer. Materials and methods. A case of recurrent papillary thyroid cancer in a young woman who underwent surgery twice (total thyroidectomy with left radical neck dissection, right lateral and central neck redissection) is described. Before the second surgery, an abnormal right subclavian artery has been identified using computed tomography. The presence of right NLN was suspected, which was confirmed by electrophysiological neuromonitoring during surgery. The analysis of the relevant world literature showed the urgency of the issue and the lack of similar case reports in Ukrainian scientific literature. Results. Based on the computed tomography scans (with 3D reconstruction of the main vascular structures of the neck), the aberrant right subclavian artery coming from the distal part of the aortic arch was found (AL). The existence of a nerve abnormality was assumed — right NLN. By the use of electroneuromonitoring and dissection of the right vagus nerve during the operation, the vascular-nervous anomaly was confirmed, which helped avoid surgical complications leading to laryngeal dysfunction and perform a surgical treatment for cervical metastases of thyroid cancer successfully. Conclusions. When a thyroid surgery is planned, one should keep in mind the possibility of a vascular abnormality of the aortic arch with a corresponding risk of damage to the inferior laryngeal nerve, which can be non-recurrent. X-ray or sonography may reveal an aberrant location of the right subclavian artery, and the use of electroneuromonitoring may facilitate the identification of NLN to avoid its damage during the neck surgery.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
Myers PO, Fasel JH, Kalangos A, Gailloud P. Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects. Ann Cardiol Angeiol (Paris). 2010 Jun;59(3):147-154. doi:10.1016/j.ancard.2009.07.008.
Williams GD, Aff HM, Schmeckebier M, Edmonds HW, Graul EG. Variations in the arrangement of the branches arising from the aortic arch in the american whites and negroes. The Anatomical Record. 1932;54(2):247-251.
Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat. 2009 Jun;31(5):319-323. doi:10.1007/s00276-008-0442-2.
Randolph GW, Dralle H; International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011 Jan;121(Suppl 1):S1-16. doi:10.1002/lary.21119.
Cherenko SM, Larin OS, Palamarchuk VO. The role of intraoperative electro-physiological monitoring of laryngeal nerves in thyroid surgery. Clin Endocrinol Endocrin Surg. 2009;(28):29-35. (in Ukrainian).
Donatini G, Carnaille B, Dionigi G. Increased detection of non-recurrent inferior laryngeal nerve (NRLN) during thyroid surgery using systematic intraoperative neuromonitoring (IONM). World J Surg. 2013 Jan;37(1):91-93. doi:10.1007/s00268-012-1782-y.
Gao EL, Zou X, Zhou YH, Xie DH, Lan J, Guan HG. Increased prediction of right nonrecurrent laryngeal nerve in thyroid surgery using preoperative computed tomography with intraoperative neuromonitoring identification. World J Surg Oncol. 2014 Aug 20;12:262. doi:10.1186/1477-7819-12-262.
Toniato A, Mazzarotto R, Piotto A, Bernante P, Pagetta C, Pelizzo MR. Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg. 2004 Jul;28(7):659-661. doi:10.1007/s00268-004-7197-7.
Avisse C, Marcus C, Delattre JF, et al. Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Surg Radiol Anat. 1998;20:227-232. doi:10.1007/BF01628900.
Konschake M, Zwierzina ME, Pechriggl EJ, et al. The nonrecurrent laryngeal nerve: A clinical anatomic mapping with regard to intraoperative neuromonitoring. Surgery. 2016 Jul;160(1):161-168. doi:10.1016/j.surg.2015.12.021.
Galushko DA, Asmaryan AG, Pasko MA. Clinical anatomy and features non-recurrent inferior laryngeal nerve in thyroid surgery. Case report. Clinical and experimental thyroidology. 2016;12(3):31-36. doi:10.14341/ket2016331-36. (in Russian).
Shidlovskiy VO, Shidlovskiy OV, Deykalo IM, Lipskiy VM. Standard and non-standard situations in surgery of the thyroid gland. Hospital Surgery. Journal named by LYa Kovalchuk. 2013;(3):21-24. (in Ukrainian).