Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax

Subclavian Arteries

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed

The right subclavian artery may arise directly from the arch of the aorta, or as the first, second, third, fourth or even the fifth branch of that vessel. When it arises as the first branch, it takes the place usually occupied by the brachiocephalic. When it arises as the distal or last branch, it may course behind the trachea (retrotrachea) or both the trachea and esophagus (retroesophageal) to reach the groove on the first rib. Hommel (1737) described the first autopsy specimen of the right subclavian artery arising as the last branch of the aortic arch. In 1789, but not reported until 1794, Bayford described the first patient and subsequent autopsy of this patient with this unusual right subclavian artery. Cairney (1925) summerized the results of eight investigators who reported 19 instances of this variation in 2291 autopsy subjects (~0.8 %). In four studies of 1783 bodies, the frequency of this variation was about 0.6%. The first case diagnosed in life by roentgenography was reported by Kommerell in 1936. The incidences reported by x-ray study is much less than the autopsy studies (20/15000 or ~0.13%). Haesemeyer and Gavant reported that in their radiologic study of 7174 patients 36 had aberrant right subclavian artery. The frequency being 0.5%.

In other cases in which the right subclavian is the last branch of the aortic arch it may pass between the trachea and the esophagus or it may follow a pretracheal course to reach the right side. Sometimes, when the subclavian artery passes between the trachea and esophagus it compresses both the artery and the esophagus, giving rise to a "disease" named "dysphagia lusoria" by Bayford (1794), from the term "lusus naturae," meaning a "sport of nature." An excerpt from Bayford's paper follows: "Jane Fordham, was born in Bassenbourn near Royston, in Hertfordshire, in the last year of the last century (auth. note, 1699). From her infancy she was observed to have some difficulty in swallowing, but it was not much attended to, till she entered into her thirteenth year, when she first experienced those symptoms which commonly precede the erruption of the menses. At this time it became so considerable as induced her to have recourse to medicine for relief; but she received no sensible benefit from anything, except repeated bleeding.... She went on in this way, with the disease gradually increasing for many years, during which time she constantly observed, that her difficulty of swallowing was increased by violent exercise, and as she expressed herself, by everything that heated her blood; so that she was frequently obliged to lose blood once or twice in the intervals of the month.... For the last twenty years of her life this poor creature could scarcely, from day to day, muster up resolution to force food down to prevent her starving, so much was the difficulty now increased.

This difficulty she described as arising from an obstruction opposite the first bone of the sternum. The food did not return when it came to that place; but seemed to make a momentary stop: and in the instant she felt an inexpressible something approaching to strangulation of suffocation, which she could only compare to what she conceived of the agonies of death..... Different kinds of foods made no sensible difference in the effects, except that solids gave her less uneasiness than fluids: for which reason she took very sparingly of the latter. As her complaints were continually aggravated, rather than diminished by time, she became at length unable to struggle; and being worn out with fatigue and famine (for it is asserted that she scarcely swallowed a single morsel for the last three weeks of her life), she sunk into her grave in the beginning of February, 1761. I felt my self interested in making an inquiry into the cause of the obstruction by an examination of the dead body. It was not thought necessary to open the head, as there was no reason to expect any mischief in that part. The cavities of the thorax and abdomen were fully examined.... At length by mere accident I discovered an extraordinary lusus naturae in the disposition of the right subclavian artery. The right subclavian arising from the posterior part of the aorta, behind on the left hand of the left subclavian. In crossing from the left to the right it... insinuated itself between the trachea and esophagus. It should seem that this peculiar origin and course of the right subclavian artery has hitherto escaped the observation of the anatomists, otherwise in all probability it would have been recorded.... It is impossible to suppose the act of deglutition performed in this case, without a certain degree of pressure upon the artery, where it passes between the trachea and esophagus. Hence must arise an interruption of the circulation, which in so large an artery, and so near the heart, could scarcely fail of exciting very disagreeable sensation.... The act of deglutition will not be accompanied with pain or soreness, but extreme anxiety and violent palpitations of the heart." This is the end of Bayfords report.

The subclavian is rarely the second or third branch of the aortic arch, but when it is, it runs behind the right common carotid.

The right subclavian arises, embryologically, as the distal or last branch of the aortic arch when the right aortic arch remains intact and the normal root of the subclavian artery has become obliterated. An arteria aberrans, arising from the right subclavian (or superior intercostal), can generally be traced to the third thoracic vertebra behind the esophagus, and in a number of such cases can be followed across the vertebral column where it anastomoses with a branch of the thoracic aorta arising below the ductus arteriosus. It is the enlargement of this anastomosis (which is the remnant of the primitive right dorsal aorta in the embryo) that gives rise to the variation. The recurrent laryngeal nerve in such cases follows a direct course to the larynx instead of winding recurrently around the subclavian artery, because the right fourth arch that forms the first part of the subclavian is obliterated.

The right subclavian may arise higher or lower in the neck than usual, depending on whether the brachiocephalic divides above or below its normal position. On occasion the subclavian arises from the thoracic aorta.

The subclavian may perforate or pass in front of the scalenus anterior; when it perforates scalenus anterior, arterial rings may be formed around muscle slips. The artery can ascend above or remain below the level of the clavicle. The third part of the artery may be covered by the trapezius or sternocleidomastoid, or by the clavicular origin of the omohyoid. The subclavian vein occasionally accompanies the artery behind scalenus anterior; the artery may also pass between scalenus medius and posterior. The right subclavian artery may receive the thoracic duct; the left subclavian may receive a patent ductus arteriosus.

The subclavian artery divides in some cases at the medial border of scalenus anterior muscle, with the two branches continuing through the axilla and down the arm to become the radial and ulnar arteries.

Anomalous right subclavian arteries occur in 0.4-1.7% of individuals (all sources). Quain reported 4 cases/1000, Holzapfel 6/1000, and Tiedemann 8 times/1000 cases. Goldbloom reported 4/225 cadavers (1.7%), Harvey (U. Cal. Medical School) found 2/237 (0.8%), Cobey reported inThomson's Collective Investigation of the Anatomical Society of Great Britain and Ireland 5/500 (1%). It is interesting that the course of the sublavian artery was retroesophageal (between the vertebra and the esophagus) most commonly (107/238 cases), retrotracheal (between the trachea and esophagus) seldom (25/238 cases), before the trachea (in-front of) most rarely (6/238 cases).

If a cervical rib is present, the artery may run above this extra, unusual rib.

In cases of right aortic arch, the left subclavian artery may be retroesophageal when it arises as the last branch of the arch. The left subclavian may be doubled and arise as the first and the fifth branch of the aortic arch. The last branch is retroesophageal.

In cases of right aortic arch, the left subclavian shows two principal variations: 1) with the left subclavian arising as the first major vessel of the right aortic arch it crosses the anterior aspect of the trachea to reach the left side and 2) with the left subclavian artery arising as the last branch of the aortic arch, it crosses the posterior aspect of the esophagus to reach the left side. The left subclavian does not arise from the aortic arch directly but from a diverticulum, a remnant of the fourth left branchial arch.

Holzapfel, who studied the course of 133 cases of the right subclavian arising as the last branch of the aortic arch found that in 107 cases (80%) the right subclavian passed behind the esophagus to reach the right side, between the trachea and esophagus in 20 cases (15%), and in front of the trachea in 6 cases (5%). Banchi reported on 165 cases; 138 cases (83.6%) behind the esophagus, 21 cases (12.7%) between trachea and esophagus, and 7 cases (4.2%) in front of the trachea. Cairney, 1925, summarized the data of eight authors and reported 19 instances of variable right subclavian artery in 2291 autopsy specimens. Others have reported an incidence from 0.4% to 2.0% in anatomic studies. The first case diagnosed of a living patients by roentgenology was reported by Kommerell in 1936, but the incidence of cases detected by X-ray is less than in autopsy series. Brombart found only 20 cases (0.13%) in about 15,000 subjects.

Alphabetical listing of authors and dates of reported cases of the unusual course of the right subclavian artery when it arises as the last branch of the aortic arch - before 1900.
From Holzapfel, 1899.

Image 43, Image 61, Image 311Image 509

Retroesophageal

Image 190, Image 233, Image 425

Right

See Image 61, Image 88, Image 99, Image 150, Image 151, Image 152, Image 159, Image 163, Image 166, Image 167, Image 168,Image 179, Image 180, Image 181, Image 182, See Image 190, Image 230, Image 231, Image 285

Retrotracheal

See Image 43

Arteria Lusoria Dextra (Right) and Arteria Subclavia Dextra Lusoria

See Images 230, 231, 394

Arteria Lusoria Sinistra (Left)

See Image 425

References

Abbott, M. (1936) Atlas of Congenital Cardiac Disease. American Heart Assoc., New York.

Anile, A. (1898) Di un'importante anomalia artero - nervosa (arteria succlavia di destra e nervo laryngeo inferiore corrispondente). La Riforma Medica 2:411-416.

Anon., (1791) Origine bizarre de I'artère sous-clavière. J. de Medecine, Chirurgie, Pharmacie, Dc. 86:239-241.

Anson, B.J. (1936) The anomalous right subclavian artery. Surg., Gynecol. Obstet. 62:708-711.

Arendt, J. and A. Wolf. (1947) The vallecular sign: Its diagnosis and clinical significance. Am. J. Roentgenology (AJR) 57:435-445.

Autenrieth, -. (1807-08) Zusatz zu der Abhandlung: De Dysphagia lusoria. Arch. Physiol. 8:264-268.

Autenrieth, -. und -. Pfleiderer. (1807) Disseratatio inauguralis. De Dysphagia lusoria. Arch. Physiol. 7:145-188.

Bayford, D. (1794) An account of a singular case of obstructed deglutition. Mem. Med. Soc. Lond. 2:271-286.

Beabout, J.W., Stewart, J.R. and O.W. Kincaid. (1964) Aberrant right subclavian artery: dispute of commonly accepted concepts. Am. J. Roentgenol. (AJR) 92:855-864.

Bean, R.B. (1904) Observations on a study of the subclavian artery in man. Johns Hopkins Hosp. Bull. 15:203-205.

Bean, R.B. (1905) A composite study of the subclavian artery in man. Am. J. Anatomy 4:303-328.

Beaumanoir (de Brest), -. (1882) Présentation de pièces anatomiques: Sous-clavière. Bull. de la Soc. Anatomique de Paris 57:318-320.

Beaumanoir, (de Brest.), -. (1882) Anomalies artèrielles trouvées a l'autopsie d'un sujet. Bull. de la Soc. Anatomique de Paris 57:316-321.

Bereza, S. (1966) A case of aberrant subclavian artery and other neurovascular anomalies in the neck. Folia Morphol., Warsaw 25:589-599.

Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Urban & Schwarzenberg., Baltimore and Munich.

Bevier, G. (1915) An anomalous origin of the right subclavian artery. Anat. Rec. 9:785-789.

Billet, H. (1937) Suite de l'étude des rapports des branches collatérales de la sousclavière avec les troncs primaires du plexus brachial. Assoc. Anatomistes Comptes Rendus 32:49-52.

Blair, D.M., Davies, F. and W. McKissock. (1934-35) The etiology of the vascular symptoms of cervical rib. Br. J. Surg. 22:406-414.

Blalock, A. (1947) Technique of creation of an artificial ductus arteriosus in the treatment of pulmonary stenosis. J. Thoracic Surgery 16:244-254.

Blumgart, H.L. and A.S. Freedberg. (1955) Arterial malformations which cause compression of the trachea or esophagus. Circulation 11:133-134.

Bochdalek, Jr., -. (1867) Einsenkung des Lig. arteriosum (Ductus arteriosus Botalli) in die linke Arteria subclavia. Arch. Pathol. Anat. Physiol. Klin. Med. 41:259-260.

Bothezat, P. (1891) Anomalie de l'artère sous-clavière droite. Montpellier Médical Series 2, 16:418-420.

Bouchet, P. (1903) Anomalie de naissance et de trajet de l'artère sous-clavière droite. Bull. et Mém. de la Soc. Anatomique de Paris. 5:155.

Boyd, G.I. (1934) Abnormality of subclavian artery associated with presence of the scalenus minimus. J. Anat. 68:280-281.

Bradley, S.M. (1871) Note on a peculiar origin of the right subclavian artery. J. Anat. Physiol. 5:341-342.

Branscom, J.J. and J.H.M. Austin. (1973) Aberrant right subclavian artery. Findings seen on plain chest roentgenograms. American Journal of Roentgenology, Radium Therapy and Nuclear Medicine (AJR) 119:539-542.

Brean, H.P. and E.B.D. Neuhauser. (1947) Syndrome of aberrant right subclavian artery with patent ductus arteriosus. Am. J. Roentgenology (AJR) 58:708-716.

Brewer, -. (1791) Observation, par M. Bayford. Déglutition empêchée par la position extraordinaire de l'artère sous-claviere. J. de Chirurgie 2:281.

Brombart, M. et J. Schuemans (1951) Pathologie meconnue de l'esophage. Acta O.R.L. Belgica 5:5-45.

Buschendorff, C. (1917) Beitrag zur Kenntnis der Persistenz eines doppelten Aortenbogens und seine klinische Bedeutung. Zentralblatt für Herz- und Gefasskrankheiten 9:165-171.

Cairney, J. (1924-1925) The anomalous right subclavian artery considered in the light of recent findings in arterial development; with a note on two cases of an unusual relation of the innominate artery to the trachea. J. Anat. 59:265-296.

Calori, L. (1868) Delle anomalie piu importanti di ossa, vasi, nervi, e muscoli occorse nell'ultimo biennio facendo anatomia del corpo umano. Mem. della Accademia delle Scienze dell'Istituto di Bologna, S.2. 8:417-482.

Calori, L. (1890) Sopra un caso d'inversione dei condotti toracici accompagnato da inversa origine dell'arteria succlavia destra e sulla genesi della due anomalie. Mem. R. Accad. Sci. Istituto di Bologna, S.5. 1:189-196.

Carrier, A.E. (1880) Pecularities in the origin and course of Arteries of the upper extremities. Toledo Med. Surg. J., Ohio 4:365-367.

Casali, R. (1911) Di tre rami soprannumerari non ancora descritti dell'A. succlavia. Arteria del muscolo succlavio, Arteria della cupola pleurica, Arteria esfogea superiore. Arch. Ital. Anat. Embriol. 10:122-128.

Casali, R. (1912) Osservazioni sui rami collaterali dell'a succlavia. Bibliographie Anatomique 22(2):41.

Chacón, F. de P. (1892) Anomalia de la arteria subclavia. Gaceta Médica de Mexico 28:442-446.

Cobey, J.F. (1914) An anomalous right subclavian artery. Anat. Rec. 8:15-19.

Coplemann, B. (1945) Anomalous right subclavian artery. Am. J. Roentgenol. (AJR) 54:270-275.

Costa, A.J. (1946) A proposito de una anomalia arterial. La arteria subclavia derecha saliendo del cayado aortico en su porción final. Rev. Assoc. Méd. Argentina 60:740-743. Cited in Excerpta Medica, Sec. 1, Vol. 2, abstract 525, p.250, 1948.

Coues, E. (1880) Anatomical anomalies. The Medical Record, N.Y. 17:257.

Craig, W.B. (1880) Unusual origin of the subclavian artery. Gaillards Medical Journal 30:428-429.

Curnow, J. (1888) Right subclavian artery passing in front of the scalenus anticus. Proc. Anat. Soc. of Great Britain and Ireland. J. Anat. Physiol. 22:v-vi.

Dahm, M. (1940) Zür Eindellung der Spieseröhre bei links entspringender Arteria subclavia dextra. Fortschr. Röntgenstr. 62:108-114.

Dalton, A. and W.F. Alexander. (1947) Anomalous right subclavian artery originating from the descending aorta. Anatomical Record 97:328.

Daseler, E.H. and B.J. Anson. (1959) Surgical anatomy of the subclavian artery and its branches. Surg., Gynecol. Obstet. 108:149-174.

Davies-Colley, N., Taylor, F. and B.N. Dalton. (1873) Left carotid arising from the innominate. Guy's Hosp. Reports 18:389-401.

Deaver, J.B. (1888/89) Anomalies of the arch of the aorta. Univ. Med. Mag., Philadelphia 2:40-41.

DeGaris, C.F. (1924) Patterns of branching of the subclavian artery in white and negro stocks. Am. J. Phys. Anthrop. 7:95-107.

DeGaris, C.F. (1932) Aortic axillary collaterals and the pattern of arm arteries in anomalous right subclavian artery. Am. J. Anat. 51:189-213.

Deniker, M. (1913) Anomalies d'origine et de trajet des branches de la crosse aortique. Bull. et Mem. de la Soc. Anatomique de Paris. 88:127-129.

Denisoff, B.N. (1912) Abnormal origin of the right subclavian artery. (In Russian) Russkii Vrach 11:1069-1071.

Dolgopol, V.B. (1934) Anomalous origin of the right subclavian from the descending arch of the aorta. J. Tech. Methods 13:112-118.

Dolgo-Saburoff, B. (1933) Zur Frage über die Lagebeziehungen zwischen der Arteria subclavia und Scalenusmuskulatur beim Menschen. Anat. Anz. 76:97:113.

von Düben, G. (1876) Abnorm verlaufende Arteria subclavia dextra. Svenska Läkaresällskapet, Förhandlingar vid 38:81-82.

Dubreuil, -. (1837) Déplacement et anomalies de rapport des veine et artère sous-clavières droites ayant mis obstacle a la ligature de ce dernier vaisseau.- Indication de quelques variétés dans l'origine et le trajet des artères sous-clavières. Gaz. Médicale de Paris 2th series, 5:562-565.

Dubreuil, -. (1862) D'anomalie d'origine de l'artère sous-clavière droite. Bull. et Mém. de la Soc. Anatomique de Paris. 37:443.

Dubreuil, -. (1862) Exemple d'anomalie d'origin de l'artère sous-clavière droit. Bulletins et Mem. de la Société Anatomique de Paris XXXVII(12):443.

Dunn, L.A., Washburn, J.W. and J.H. Targett. (1890) Abnormalities observed in the dissecting room of Guy's Hospital during sessions 1888-1890. S. 3., 32:299-315.

Eklöf, O., Ekström, G., Erikson, B.O. et al. (1971) Arterial anomalies causing compression of the trachea and/or the esophagus. Acta Pediatr., Scand. 60:81-89.

Farlow, J. W. (1886) Abnormal artery of the pharynx. Boston Medical and Surgical Journal. CXIV(19):437-438.

Faure, J. -L. (1895) Anomalie d'origine de l'artère sous-clavière droite. Bull. et Mem. de la Societe Anatomique de Paris 9:11-12.

Felson, B., Cohen, S., Courter, S.R. and J. McGuire. (1950) Anomalous right subclavian artery. Radiology 54:349-349.

Fischer, J. (1858) Verlauf der art, subclavia in einem Falle von deutlich entwickelten Halsrippen. Wiener Medizinische Wochenschrift 8 (No. 30) 24 Juli:537-539

Fossei, H.M. (1942) Ueber Dysphagia lusoria. Fortschr Röntgenstr. 79(3):111-112.

Freed, K. and V.H.S. and Low (1996) The aberrrant subclavian artery. AJR 168:481-484.

Furukawa, H. and T. Takemurs. (1995) Stanford type A acute aortic dissection involving an aberrant right subclavian artery: a successful operative case. (In Japanese). Nippon Kyobu Geka Gakkai Zasshi 43:533-537.

García Cañizares, D.F. Anomalias Arteriales. Revista de Ciencias Medicas 10: 75-77.

Geddes, A.C. (1911) A note on abnormal right subclavian artery. J. Anat. Physiol. 45:197-198.

Geddes, A.C. (1911) Note on the reputed passage of abnormal right subclavian artery (A) in front of the trachea, (B) between the trachea and oesophagus. J. Anat. Physiol. 45:199-201.

Giannelli, L. (1894) Sopra alcune Anomalie dei vasi. Atti d. R. Accad. d. Fisiocritici in Siena. S.4. 6:363-370.

Gladstone, R.J. and C.P.G. Wakeley. (1915) Two cases, considered from the developmental standpoint, in which the right subclavian artery arose from the arch of the aorta beyond the origin of the left subclavian artery; with a note on the relation of the subclavian veins to the cardinal system. J. Anat. Physiol. 49:362-374.

Goldbloom, A.A. (1922) The anomalous right subclavian artery and its possible clinical significance. Surg., Gynecol. Obstet. 34:378-384.

Golub, D.M. (1929) Ein Fall eines anomalen Ursprungs der A. subcl. dextra unterhalb der A. subcl. sin. kombiniert mit dem Tr. bicaroticus und einem rechtsseitigen Münden des Ductus thoracicus. Anat. Anz. 67:387-392.

Gould, E.L.P. (1909) A case of abnormal right subclavian artery. J. Anat. Physiol. 43:324-328.

Gross, C., Prebl, F. and P. Brucke. (1990) Thoracic aneurysm in association with an aberrant right subclavian artery. Eur. J. Cardiothoracic Surg. 4:105-106.

Gross, R.E. (1946) Surgical treatment for dysphagia lusoria. Ann. Surg. 124:532-534.

Gross, R.E. (1955) Arterial malformations which cause compression of the trachea or esophagus. Circulation 11:124-134.

Gross, R.E. and E.B.D. Neuhauser. (1951) Compression of the trachea or esophagus by vascular anomalies. Surgical therapy in 40 cases. Pediatrics 7:69-88.

Gross, R.E. and P.F. Ware. (1946) Surgical significance of aortic arch anomalies. Surg., Gynecol. and Obstet. 83:435-448.

Guiria, P.M. (1890) Ancora del rapporto che si stabilisce fra l'A. vertebrale destro e il N. laringeô inferiore, quando ecc. Mem. della R. Accademia Medica di Genova 1890:7-17.

Günsel, E. (1940) Dysphagia lusoria bei Arcus aortae dexter und sinister. Röntgenpraxis 12:346-348.

Haesemeyer, S.W. and M.L. Gavant. (1999) Imaging of acute traumatic aortic tear in patients with aberrant right subclavian artery. AJR 172:117-120.

Hamann, C.A. (1900) Right subclavian artery passing behind the trachea and esophagus - other anomalies. Cleveland J. Med. 5:453-455.

Hammer, D.L. and A.M. Meis. (1941) Thyroid arteries and anomalous subclavian in the white and negro. Am. J. Phys. Anthropol. 28:227-237.

Hanai, H., Ryúmon, A., Kamakura, K. and S. Kaneko. (1963-64) An anomalous case of A. Subclavia dextra rising from arcus aortae as the last branch. Okajimas Folia Anatomica Japonica 39:31-36.

Hart, J. (1826) A case of irregular origin and course of right subclavian artery. Edinburgh Med. J. 25:286-287.

Harvey, R.W. (1917) Notes on two cases of anomalous right subclavian artery. Anat. Rec. 12:329-330.

Haug, H. and U. Merkel. (1965) Abnormer Ursprung und Verlauf der A. subclavia dextra. Anat. Anz. 117:319-321.

Herbut, P.A. (1943) Anomalies of the aortic arch. Arch. Pathol. 35:717-729.

Herringham, W.P. (1891) Right aorta with persistent left aortic root giving origin to the left subclavian. Proc. Anat. Soc. J. Anat. Physiol. 25:vi-vii.

Holtzapfel, G. (1899) Ungewöhnlicher Ursprung und Verlauf der Arteria subclavia dextra. Anat. Hefte 12:369-523.

Hopkinson, J.P. (1831) Aneurism of the aorta, and usual origin of right subclavian. Am. J. Med. Sci. 7:556-557.

Hudson, W.A. (1921) A case of an anomalous right subclavian artery. Washington University Studies. IX, Scientific series 1:219-228.

Hunauld, L. (1735) Examen de quelques parties d'un singe. Hist. Acad. Roy. Sci. 2:516.

Jacques, P. (1895) Quelques anomalies artèrielles (sous-clavière droite, tronc coeliaque, poplitée). Bull. et Mém. de la Société Anatomique de Paris 70:252-255.

Kalbfleisch, H.H. (1948) Durch morphologische Veränderungen nachweisbare funktionale Segmente in Pharynx, Hypopharynx und Oesophagus. Allgemeinpathol. Schriften: Beitr. zur allgemein. path. aus der Spezialen Path. 7:5-25.

Kaplan, E.B. (1947) Variations of the subclavian vessels in the region of the scalenus anterior muscle. N.Y. Hosp. Joint Dis. Bull. 8:217-218.

Kirby, J. (1818) A case in which suffocation was produced by a portion of solid food in the oesophagus. The Dublin Hospital Reports and Communications in Medicine and Surgery 2:224-226.

Klinkhamer, A.C. (1966) Aberrant right subclavian artery. Clinical and roentgenologic aspects. Am. J. Roentgenology (AJR) 97:438-446.

Kodama, K. (1935) Two cases of the right subclavian artery as the last branch of the aortic arch. Mitt. Med. Akad. Kioto 14:961-964.

Kommerell, B. (1936) Verlagerung des ösophagus durch eine abnorm verlaufende Arteria subclavia dextra (Arteria lusoria). Fortschr. Röntgenstr. 54:590-595.

Kroeker, E.J., Kirklin, J.W., Prickman, L.E. and E.H. Wood. (1954) Coarctation of the aorta, subaortic stenosis, anomalous right subclavian artery: Report of case. Staff Meetings of the Mayo Clinic 29(10):266-277.

Krokowski, E. (1960) Arteria lusoria. Fortschr. Röntgenstr. 93:376-377

Langman, J. (1954) Oesophageal atresia accompanied by a remarkable vessel anomaly. Archivum Chirurgicum Neerlandicum 4:39-42.

Lombardi, G. (1936) Il quadro radiologico della arteria lusoria (arteria succlavia destra anomala). Radiol. Med. 37:809-816.

Mears, J.E. (1871) Description of an anomalous origin of the right subclavian artery, associated with anomalies of origin of the branches of both subclavian arteries; with remarks. Am. J. Med. Sci. 62:401-409.

Menke, J.F. (1936) Anomalous a. bronchialis dextra from the a. subclavia dextra, secondarily connected to the aorta thoracalis. Anat. Rec. 65:55-58.

Michaud, -et A. Antoine. (1834) Anomalies dans la mode dorigine des branches de la crosse aortique. J. des Sciences Medicales de Montpellier 1:177-180.

Milianitch, M.N. (1924) Note sure une anomalie d'origine des grostrones nés de la crosse de l'aorte accompagné d'une anomalie de trajet du nerf récurrent droit. bull. et Mém de la Soc. Anatomique de Paris. 94:230-233.

Moreira da Rocha, J. (1926) Arteria subclavia direita como ultimo ramo da crossa aortica. Ann. da Faculd. de Med. de São Paulo, Brasil 1:103-124.

Mouton, C. (1919) Ueber Anomalien der Arteria subclavia dextra und ihre Folgezustände (Dysphagia lusoria). Brun's Beiträge zur Klinischen Chirurgie 115:365-407.

Nakagawa, M. (1938) On the right subclavian artery as the last branch of the aortic arch. (In Japanese) Juzenkai Z. 44(1):203-216.

Nathan, H. and M.R. Seidel. (1983) The association of a retroesophageal right subclavian artery, a right-sided terminating thoracic duct, and a left vertebral artery of aortic origin: Anatomical and clinical considerations. Acta Anat. 117:362-373.

Natsis, K., Didagelos, M., Gkiouliava, A. et al. Surg Radiol Anat (2016). doi:10.1007/s00276-016-1796-5

Neuhauser, E.B.D. (1946) Roentgen diagnosis of double aortic arch and other anomalies of the great vessels. Am. J. Roentgenol. (AJR) 56:1-12.

Nizankowski, C. Noczynski, L. and E. Suder. (1982) Variability of the origin of ramifications of the subclavian artery in humans (studies on the Polish population). Folia Morphol., Warsaw 41:281-294.

O'Rahilly, R., Debson, H. and T.S. King. (1950) Subclavian origin of bronchial arteries. Anat. Rec. 108:227-238.

Ozenne, -. (1883) 12. Anomalie d'origine de la carotide droite et de l'artère sous-clavière du même côté. Bull. de la Société Anatomique de Paris, 4th series, 8:108.

Ozenne, -. (1883) 12. Anomalie d'origine de la carotide droite et de l'artère sous-clavière du même côté. Le Progrès Médical 11:734.

Palmer, E.D. (1955) Dysphagia lusoria: Clinical aspects in the adult. Annals of Internal Medicine 42 (6):1173-1180.

Papadatos, D. (1976) Trois observations anatomiques sur l'origine de l'arteria subclavia dextra comme denière branche de l'arcus aortae (arteria lusoria). Anat. Anz. 140:100-117.

Patterson, Jr., J.F. (1946) Cervical ribs and scalene anticus syndrome: review of literature and report of a case. N. Carolina Med. J. 7:13-20.

Pattison, J.N. (1953) Anomalous right subclavian artery. Br. Heart J. 15:150-158.

Pellegrini, A. (1904) Il tipo normale e le variazioni delle arteriae subclavia e axillaris. Monitore Zoologico Italiano 15:232-244.

Pellegrini, A. (1906) Le arteriae subclavia e axillaris nell'uomo studiate col metodo statistico. Arch. Ital. Anat. Embriol. 5:205-255.

Pertik, O. (1880) Ueber Dysphagia lusoria und deren anatomische Ursache. Pester Medizinisch-Chirurgische Presse 1880 -16:5-8, 20-22, 56-74.

Philips, W.E., Murtaugh, F.R. and J. Brenner. (1993) Recognition of the aberrant right subclavian artery on cervical spine MR. AJNR (Am. J. Neuro. Radiol.) 14:1405-1406.

Poker, N., Finby, N. and I Steinberg. (1958) The subclavian arteries: Roentgen study in health and disease. Am. J. Roentgenology (AJR) 80:193-216.

Poynter, C.W.M. (1916) Arterial anomalies pertaining to the aortic arches and the branches arising from them. The Univ. Studies of the Univ. of Nebraska 16:229-345.

Poynter, C.W.M. (1922) Congenital anomalies of the arteries and veins of the human body with bibliography. The Univ. Studies of the Univ. of Nebraska. 22:1-106.

Proto, A.V., Cuthbert, N.W. and L. Raider. (1987) Aberrant right subclavian artery: further observations. Am. J. Roentgenology (AJR) 148:253-257.

Pujol, D.J.T. (1915-17) Un caso de anomalia de la arteria subclavia derecha y su explicación embriogenica. Arquivo de Anat. e Anthropol. 3:17-27.

Raider, L. (1967) Aberrant right subclavian artery. South. Med. J. 60:145-151.

Raphael, R.L., Schnabel, T.G. and S.S. Leopold (1952) A new method for demonstrating an aberrant right subclavian artery. Radiology 58:89-93.

Ravelli, A. (1950) Die Arteria lusoria im Röntgenbild. Fortschritte Röntgenstrahlen 73:285-288.

Rao, V.R. and G.R.K H. Rao. (1956) Anomalous right subclavian artery. J. Anat. Soc. India 5:74-77.

Renander, A. (1926) Roentgen-diagnosed anomaly of oesophagus and arcus aortae. Dysphagia Lusoria. Acta Radiol. 7:298-308.

Robicsek, F., Sanger, P.W. and H.K. Daugherty. (1968) Angiographic picture of dysphagia lusoria. Vasc. Surg. 2:29-40.

Roncoroni, L. (1956) La destro-posizione pura dell'arco aortico. Ann. di Radiologia Diagnostica 29:315-330.

Roszel, A. (1966) über die Anomalie der Arteria subclavia dextra und die Persistence der Vena cava superior sinistra. Anat. Anz. 118:348-367.

Sasaki, J., Masaki, S. and T Suzuki. (1968) Anomalous right subclavian artery. Pract. Oto-Rhino-Laryng. 30:289-294.

Schmitt, H.E., Ludin, H., Elke, M. and G. Schock. (1966) Arcus aortae dexler mit Abgang der Arteria subclavia sinistra aus einem rudimentaren linken Aortenbogen. Fortschritte Röntgenstrahlen. 104(2):268-270.

Schmidt, J. (1953) Die Arteria lusoria: Zusammenfassende Darstellung unter Berücksichtigung eigener Untersuchungen. Arch. für Kreislaufforsch. 19:1-37.

Sealy, W.C. (1951) A report of two cases of the anomalous origin of the right subclavian artery from the descending aorta. J. Thoracic Surg. 21:319-324

Segers, M. (1950) L'insertion gauche de l'artere sous-claviere droite. Acta Cardiologica 5:182-187.

Shellshear, J.L. and J. Anderson. (1927) Oesophageal atresia associated with an abnormal right subclavian artery. China Medical Journal 41:103-106.

Singh, A. (1978) A very rare anomalous branching pattern of the arch of the aorta: two right subclavian arteries. Proc. Anat. Soc. India, 26th Ann Conference, 1977. Proc. 75, p.42. J. Anat. Soc. India 27:42-43.

Singh, B., Mukerjee, R.N. and S.S. Makhni. (1959) Anomalous right subclavian artery. J. Anat. Soc. India. 8:34-35.

Skopakoff, C. (1964) über die Variabilität der Abzweigung der A. subclavia und ihrer Hauptäste. Anat. Anz. 115:393-402.

Skopakoff, C. (1965) über die Variabilität der Abzweigung der A. subclavia und ihrer Hauptäste. II. Abzweigung der Hauptäste der A. subclavia. Anat. Anz. 116:73-91.

Slager, R.F. and K.P. Klassen. (1958) Anomalous right subclavian artery arising distal to a coarctation of the aorta. Ann. Surg. 147:93-97.

Solger, -. (1893) Abnormen Ursprung der Art. subclavia. Deutsche Med. Wochenschr. 19:1132-1133.

Spence, J. (1855) Case of irregularity of vessels at root of neck. Monthly Journal of Medicine 20:350.

Stahel, H. (1886) Zur Anatomie und Chirurgia der Art. subclavia. Arch. Anat. Physiol. Wissen. Med. 1886:211-235.

Suarez de Lezo, J., Montero Argudo, J., Pasalodos Pita, J., Fernandez Garcia, J.C., Arizon del Prado, J.M., Concha Ruiz, M. and F. Valles Belsue. (1980) Vascular ring caused by an abnormal right subclavian artery and common carotid trunk. Rev. Esp. Cardiol. 33(5):553-557.

Stauffer, H.M. and H.H. Pote. (1946) Anomalous right subclavian artery originating on the left side as the last branch of the aortic arch. Am. J. Roentgenol. (AJR) 56:13-17.

Stebbins, T.A. (1949) A report of a case of an anomalous right subclavian artery in man with a rare arrangement of the associated arteries. Anat. Rec. 103:139-149.

Stedman, G. W. (1823) A singular distribution of some nerves and arteries in the neck and the top of the thorax. The Edinburgh Med. and Surg. J. 19:564-566.

Stewart, J.R., Kincaid, O.W. and J.E. Edwards. (1964) An Atlas of Vascular Rings and Related Malformations of the Aortic Arch System. Charles C Thomas, Publisher, Springfield.

Stone, W.M., Brewster, D.C., Moncure, A.C., Franklin, D.P., Cambria, R.P. and W.M. Abbott. (1990) Aberrant right subclavian artery: varied presentations and management options. J. Vasc. Surg. 11:812-817.

Stutz, E. (1947) Dysphagia lusoria. Klin. Wochenschr. 24/25:846-847.

Sunderland, S. and G.M. Bedbrook. (1949) Narrowing of the second part of the subclavian artery. Anat. Rec. 104:299-307.

Taniguchi, Y. (1935) An anomalous case of the right subclavian artery branching from the aortic arch as the last branch. (In Japanese) J. Osaka Med. College 2(2):15-20.

Tenchini, L. (1879) Una anomalia dell' arteria succlavia. Gazzetta Medica Italiana Lombarda 1:33-34.

Thompson, W.H. (1890) Abnormal right subclavian artery. Lancet I: 352.

Todd, T.W. (1913) The arterial lesion in cases of cervical rib. J. Anat. Physiol. 47:250-253.

Umesue, Y. (1937) Anomaly of the branches of the aortic arch. (In Japanese) Kyushu Igk. Z. 2(4):473-475.

Valentin, L. (1791) Origine bizarre de l'artère sous-clavière droite. J. d. Méd, Chir. Pharm., &c., Paris 86 (Abt. 1):239-241.

Vandendorp, F., Lemaitre, G. et Cl. Belbenoit. (1951) Un cas de "Dysphagia lusoria". Archives des Maladies de l'Appareil Digestif et des Maladies de la Nutrition 40:1233-1236.

Vittorini, L. (1831) Anomali anatomiche osservate del dottor Lobovico Vittorini. Carotide dritta nascente direttamente dall'arco dell'aorta. Annali Universali di Medicina e chirurgia 6:585.

Walter, M. (1785) Sur les maladies du coeur. Nouveaux Mémoires de l'Académie Royale des Sciences et Belles-Lettres. 1785:57-66.

Windle, W.F., Zeiss, F.R. and M.S. Adamski. (1928) Note on a case of anomalous right vertebral and subclavian arteries. J. Anat. 62:512-514.

Winslow, J.B. (1775) Exposition anatomique de la structure du corps humain. Avec approbation et privilege du roi. La Veuve Savoye... 2(19-20):351-353.

Winslow, R. (1883) A study of the malformations, variations, and anomalies of the circulatory apparatus in man. Annals of Anatomy and Surgery 7:14-15.

Wood, J. (1859) Two specimens of abnormal origin of the right subclavian artery. Trans. Path. Soc. Lond. 10:119-128.

Work, W.P. (1941) Unusual position of the right recurrent laryngeal nerve. Ann. Otol., Rhin. & Laryngology 50:769-775.

Wurtz, K.G. and N.B. Powell (1948) Two unusual vascular and cardiac anomalies. I. Vascular ring of the esophagus with patent ductus arteriosus. Origin of the left subclavian and carotid arteries. II. Persistent atrioventricular communis and aortic dextroposition with mongolism. J. Pediatr. 33:722-733.

Yazuta, K. (1927) Zur Varirtatenstatistik des Ursprunges und der Lage einiger Äste der A. subclavia. Anat. Anz. 63:139-143.

Yeager, V.L. and N. Lertparal. (1970) Heart and aortic arch anomalies: Anomalous right subclavian artery, complete interruption of the aortic arch, and associated anomalies of the heart. J. Med. Assoc. Thailand 53:279-288.

Zdansky, E. (1939) Die links entspringende Arteria subclavia dextra. Röntgendiagnostik des Herzens und der grossen Gefässe. J. Springer, Vienna.

Zoja, G. (1872) Sulla coincidenza di una anomalia arteriosa con una nervosa. Rendiconti - Istituto Lombardo di Scienze e Lettre 1872:599.

Variations in the Branches of the Subclavian Artery
There is considerable variation in the branching of the subclavian artery, and the branches may be arranged differently on the two sides of the body. The usual branching order on the right side is for the vertebral, thyrocervical trunk (common trunk for the inferior thyroid, transverse cervical, and suprascapular arteries, in 50% of cases), and the internal thoracic (internal mammary) to arise from the first part of the right subclavian. When the the ascending cervical is a branch of the inferior thyroid, the transverse cervical artery and costocervical trunk arise from the second part of the subclavian. The costocervical trunk may arise from the third part, on the right side in 75% of cases and on the left in 30%. There may be one or two branches from the third part (costocervical and dorsal scapular artery in about 35% of cases). When the dorsal scapular is absent the costocervical trunk arises from the transverse cervical at the angle of the scapula. The transverse cervical may arise from the dorsal scapular when the dorsal scapular arises from the third part of the subclavian.

There are three additional types of variations, 1) the vertebral, internal thoracic (internal mammary), costocervical, and the inferior thyroid arise from the first part of the subclavian, while the transverse cervical arises from the second part and the suprascapular from either the third part or from the axillary artery. 2) The inferior thyroid, suprascapular, and the transverse scapular arise from a common stem from the first part. 3) In the rarest form, the inferior thyroid and superficial cervical arteries arise from a common trunk from the first part of the subclavian, while the suprascapular artery arises from the internal thoracic (internal mammary).

The subclavian artery may give rise to the inferior thyroid (27 of 273 cases or 9.9%), ascending cervical, suprascapular, supreme intercostal, deep cervical, accessory root to the vertebral, thyroidea ima, accessory inferior thyroid, and radial and ulnar arteries (without the axillary artery intervening). It sometimes provides a stem that gives rise to the internal thoracic, inferior thyroid, suprascapular, superior esophageal, an accessory or lateral internal thoracic, a vessel to the brachial plexus, a pericardial branch, a bronchial, or a pleural cupula branch.

J.J. Long studied the formation of the thyroid axis (thyrocervical trunk) and in all, used 75 specimens. It was found that their were four primary modes in which the branches were distributed. The four variations follow: Variation 1.- This arrangement is the usual form of the trunk. The thyroid axis, arising from the first part of the subclavian artery, gave off three vessels- the inferior thyroid, transversalis colli (transverse cervical), and suprascapular arteries. This was found in 33 of the 75 specimens. Variation 2.- In this group the posterior (dorsal) scapular artery arose from the third part of the subclavian artery in addition to three thyroid axis branches, viz, inferior thyroid, suprascapular, and superficial cervical arteries. This arrangement was found in 22 of the 75 specimens studied. Variation 3.- The group includes cases in which an artery (transversalis colli) susequently divided into superficial cervical and posterior (dorsal) scapular arose from the third part of the subclavian, while the thyroid axis provided the inferior thyroid and suprascapular arteries. This was found in 21 of 75 specimens. Variation 4.- In these cases three arteries arose from the third portion of the subclavian, sometimes as a single trunk, dividing into three branches, or as two trunks, one of which then divided into two branches. The branches in either case took the distribution of the superficial cervical, posterior (dorsal) scapular and suprascapular arteries. The inferior thyroid artery in these cases was the only representative of the axis. This was found in 4 of 75 specimens.

It can be seen that the inferior thyroid arose from the axis with one exception. The posterior (dorsal) scapular, in 42 cases out of 75, arose fron the third part of the subclavian artery, in 22 instances as a separate trunk, in 20 being conjoined with the superficial cervical, forming the transverse cervical. The suprascapular artery was also found to be a very constant branch of the thyroid axis, there being only 4 exceptions, vide Group 4 variations. The vessels arising from the third part of the subclavian varied considerably in the exact point at which they arose, sometimes coming off close to its termination, at others quite near to its origin, and in a very few cases one of the branches actually arose from the second portion of the subclavian. These variations tended to be the same on both sides of the same subject.

See also aortic arch for additional references and discussion of subclavian artery variations.

References

Anson, B.J., Ed. (1966) Morris' Human Anatomy, 12th ed., The Blakiston Division, McGraw-Hill Book Company, New York.

Bereza, S.A. (1966) A case of aberrant subclavian artery and other neurovascular anomalies in the neck. Folia Morph., Warsaw. 25:589-599.

Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Urban & Schwarzenberg., Baltimore and Munich.

Bovero, A. (1907) Morphologie des artères de la glande mammaire. Arch. Ital. Biol. 48:486-487.

Casali, R. (1911) Di tre rami soprannumerari non ancora descritti dell'A. succlavia. Arteria del muscolo succlavio, Arteria della cupola pleurica. Arteria esofogea superiore. Arch. Ital. Anat. Embriol. 10:122-128.

Charcot, -. (1874) Anomalie de volume de l'artère sous-clavière droite. Lyon Méd. 6:499.

Coues, E. (1880) Anatomical anomalies. The Medical Record, N.Y. 17:257.

Daseler, E.H. and B.J. Anson. (1959) Surgical anatomy of the subclavian artery and its branches. Surg., Gynecol. Obstet. 108:149-174.

DeGaris, C.F. (1924) Patterns of branching of the subclavian artery in White and Negro stocks. Am. J. Phys. Anthrop. 7:95-107.

Flesch, -. (1879) Varietäten des Gefäss-Systemes. Verhandl. der Physikl-Med. Gesell. in Wurzburg. Neue Folge 13:261.

Gruber, W. (1878) Zweiwurzlige Arteria vertebralis dextra bei Ursprung der accessorischen Wurzel von einem vom Anfange der Subclavia entstandenen Truncus thyreovertebralis (und mit Vorkommen einer Arteria thyroidea ima. Arch. Path. Anat. Physiol. Klin. Med. 74:435-438.

Henle, J. (1868) Handbuch der Systematischen Anatomie des Menschen. 3 vols. Von Freidrich Vieweg und Sohn, Braunschweig.

Hird, F. (1873) Account of an anomalous distribution of the branches of the aorta, and an unusual course of the right subclavian artery. London Medical Gazette 19:702-703.

Huelke, D.F. (1958) A study of the transverse cervical and dorsal scapular arteries. Anat. Rec. 132:233-245.

Huelke, D.F. (1962) The dorsal scapular artery. A proposed term for the artery to the rhomboids. Anat. Rec. 142:57-61.

Jacques, P. (1895) Quelques anomalies artèrielles (sous-clavière droit, tronc cœliaque, poplitée) Bull. et Mém. de la Soc. Anatomique de Paris 70:252-255.

Long, J.J. (1891) Formation of the thyroid axis. Transactions - Royal Academy of Medicine in Ireland 9:483-484.

Nizankowski, C., Noczynski, L. and E. Suder. (1982) Variability of the origin of ramifications of the subclavian artery in humans (studies on the Polish population). Folia Morphol., Warsaw 41:281-294.

O'Rahilly, R., Debson, H. and T.S. King (1950) Subclavian origin of bronchial arteries. Anat. Rec. 108:227-238.

Ozenne, -. (1883) Anomalie d'origine de la cartoide droite et de l'artère sous-claviere du même côté. Bulletins de la Societe Anatomique de Paris, 4th series, 8:108.

Papadatos, D. (1976) Trois observations anatomiques sur l'origine de l'arteria subclavia dextra comme denière branche de l'arcus aortae (Arteria lusoria). Anat. Anz. 140:100-117.

Poynter, C.W.M. (1916) Arterial anomalies pertaining to the aortic arches and the branches arising from them. The University Studies of the University of Nebraska, Lincoln 16:229-235.

Poynter, C.W.M. (1922) Congenital anomalies of the arteries and veins of the human body with bibliography. The University Studies of the University of Nebraska, Lincoln. 22:1-106.

Röhlich, K. (1934-35) Uber die Arteria transversa colli des Menschen. Anat. Anz. 79:37-52.

Spence, J. (1855) Case of irregularity of vessels at root of neck. Monthly Journal of Medicine, Edinburgh 20:350.

Swigart, LaV.L., Siekert, R.G., Hambly, W.C. and B.J. Anson. (1950) The esophageal arteries. An anatomic study of 150 specimens. Surg., Gynecol. Obstet. 90:234243.

vonLanz, T. and W. Wachmuth (1955) Praktische Anatomie Ein Lehr- und Hilfsbuch der Anatomischen Grundlagen Artztlichen Handelns. Springer-Verlag, Berlin, Gottingen, Heidelberg.

Walsham, W.J. (1880) The right subclavian arising from the the third part of the arch of the aorta. Anatomical variations: An account of a few of the more interesting abnormalities that have occurred in the dissecting-rooms during the past seven years; with remarks on their significance, and their bearing on the practice of surgery. St. Bartholomews Hospital Reports 16:88-89, 90.

Additional references will be found with the section on the aortic arch.

Section Top | Title Page

URL: http://www.anatomyatlases.org/