This is a review of an article presented in the International Journal of Anatomical Variations entitled “Rare case of a five-branched aortic arch exhibiting a retroesophageal right subclavian artery and an accessory left vertebral artery.” The case involved a cadaveric specimen who exhibited an aortic arch with five branches: left subclavian artery, a retroesophageal right vertebral artery, right and left common carotid arteries, and an accessory left vertebral artery. Such a combination of five aortic arch vessels may be rare.

Keywords: Retroesophageal right subclavian artery, Aberrant right subclavian artery, Accessory left vertebral artery, Duplicate origin of the left vertebral artery, Vertebral artery variation, Head and neck vascular variations

INTRODUCTION

This article presents a case of a 76 year old White male cadaver who presented with a five-branched aortic arch. The branches included the right common carotid artery (RCCA), left common carotid artery (LCCA), left subclavian artery (LSA), an aberrant right subclavian artery (ARSA); a retroesophageal right subclavian artery (RRSA) and an accessory left vertebral artery (ALVA). Of the types of aortic arch (AA) variations, ARSAs are the most common, with an incidence of 0.1 to 2.5% and more than 100 cases described in the literature [1-30]. However, with the addition of an ALVA serving as the fifth AA branch, this case may highlight a rare variant since its characteristics have not been described in the literature previously.

Several other anatomical variations were present in this case. The left vertebral artery was hypoplastic (diameter

Aortic arch and subclavian branching variations are common and clinically significant in diagnostic imaging and surgical procedures of the head and neck. ARSAs are currently encountered more frequently due to the increasing use of a transradial approach for coronary angiography [31]. They are also important due to their common co-occurrence with a right non-recurrent laryngeal nerve in regards to performing thyroid surgery [2,5,6,8-11,22-25,32,33]. Awareness of RRSA is also significant due to their possible appearance during right axillary, brachial or radial angiographic approaches to the ascending thoracic aorta, and the possibility of a complication with a nearby arterioesophageal fistula [4,6,8-13,15-17,19,22-25,27,29,31,32,34-40]. It is also of clinical note that with this case, there was the presence of an ALVA with a hypoplastic LVA. The hypoplastic  LVA that  may  have been  missed if a thorough anatomic cadaveric dissection had not been conducted. Awareness of this anatomical variant is important for not only anatomical education purposes, but also essential for radiologists and surgeons examining the head and neck region.

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