A rare aortic-arch variant – arteria lusoria: case report with review of literature and clinical implications

Abstract

Abstract. The aberrant right subclavian artery (arteria lusoria, AL) is the most common aortic-arch branching variant, occurring in approximately 0.5–2.5% of the population. Although usually asymptomatic, AL’s retroesophageal course can produce dysphagia lusoria or respiratory symptoms and is associated with Kommerell’s diverticulum and a non-recurrent right laryngeal nerve – findings with important diagnostic and procedural implications. During routine dissection at the Medical University – Sofia, we identified an AL in an 81-year-old female cadaver. The right subclavian artery arose ≈0.5 cm distal to the left subclavian artery from the transition of the aortic arch into the thoracic aorta. The aberrant vessel followed a retroesophageal course, and the brachiocephalic trunk was absent; the right and left common carotid arteries and the left subclavian artery originated separately and without other anomalies. This cadaveric case highlights a rare but clinically relevant aortic-arch variant that may complicate right transradial coronary access, endovascular and open surgical approaches to the aortic arch and neck, and neck surgery due to likely association with a non-recurrent laryngeal nerve. Further investigation combining regional cadaveric series, imaging databases, and clinical registries is warranted to clarify local prevalence and optimize diagnostic and therapeutic pathways.