Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan.
Surg Radiol Anat. 2024 Apr;46(4):519-522. doi: 10.1007/s00276-024-03333-w. Epub 2024 Mar 13.
A right aortic arch (RAA) is a rare vascular anomaly that often coexists with an aberrant left subclavian artery (ALSA). Due to the rarity of RAA, the development of an ALSA is not well understood.
We describe a case in which a 58-year-old man who was scheduled to undergo posterior decompression and fusion surgery for thoracic ossification of the posterior longitudinal ligament from Th1 to Th3 was found to have a RAA and an ALSA.
Preoperative computed tomography angiography demonstrated a RAA and an ALSA. The ALSA was extremely tortuous and ran in the paraspinal muscles behind the thoracic laminae, which meant it was in the surgical field. The ALSA arose from the descending aorta and bifurcated into the left segmental arteries of Th1 and Th2, and also bifurcated into the left vertebral artery, which had a normal subsequent course. The dysplastic ALSA was considered to have developed from the thoracic intersegmental artery. Based on preoperative examination findings, we performed spinal surgery without vessel injury.
We report a rare case of a dysplastic ALSA that developed from the thoracic intersegmental artery with a RAA. The knowledge of this anomaly provides safety in spinal surgery of the cervicothoracic junction.
右位主动脉弓（RAA）是一种罕见的血管畸形，常伴有左锁骨下动脉异常（ALSA）。由于 RAA 较为罕见，因此对其发生的 ALSA 尚不完全了解。
我们描述了 1 例 58 岁男性患者，该患者拟行胸 1 至胸 3 后纵韧带骨化的后路减压融合术，术前检查发现其存在 RAA 和 ALSA。
术前 CT 血管造影显示 RAA 和 ALSA。ALSA 极度迂曲，走行于胸椎椎板后方的椎旁肌内，处于手术野内。ALSA 起自降主动脉，分为供应胸 1 和胸 2 的左节段动脉，也分为左椎动脉，随后正常走行。发育不良的 ALSA 被认为是从胸节间动脉发育而来。根据术前检查结果，我们在不损伤血管的情况下进行了脊柱手术。
我们报告了 1 例罕见的由 RAA 伴发的发育不良的 ALSA。了解这种异常情况可确保颈胸交界处脊柱手术的安全性。
