Rowe L D, Lowry L D, Keane W M, Fallenjad M
Ann Otol Rhinol Laryngol. 1978 Jul-Aug;87(4 Pt 1):498-508. doi: 10.1177/000348947808700407.
Congenital vascular anomalies of the aortic arch are unusual etiologies of dysphagia in the adult. Swallowing abnormalities associated with compression of the esophagus primarily occur at birth or in the immediate neonatal period. However, as the result of arteriosclerotic vascular disease or aneurysm formation, anomalies which were asymptomatic postnatally may produce dysphagia in the adult. A retrospective analysis of 59 cases with aortic arch anomalies presenting initially in adulthood revealed characteristic clinical signs and symptoms. An aberrant right subclavian artery with left aortic arch was the most frequently encountered abnormality. The embryologic development of each vascular anomaly is described and the value of selective arteriography with contrast esophagography is stressed. Patients with minimal swallowing impairment are treated with dietary management alone. Surgical division of the anomalous artery is indicated only when severe dysphagia is associated with progressive life-threatening anorexia and weight loss.
主动脉弓先天性血管异常是成人吞咽困难的罕见病因。与食管受压相关的吞咽异常主要发生在出生时或新生儿早期。然而，由于动脉硬化性血管疾病或动脉瘤形成，出生后无症状的异常可能在成人期导致吞咽困难。对59例成年期首次出现主动脉弓异常的病例进行回顾性分析，揭示了其特征性的临床体征和症状。左位主动脉弓伴迷走右锁骨下动脉是最常见的异常情况。描述了每种血管异常的胚胎发育过程，并强调了选择性动脉造影结合食管造影的价值。吞咽功能轻度受损的患者仅通过饮食管理进行治疗。仅当严重吞咽困难伴有进行性危及生命的厌食和体重减轻时，才考虑对异常动脉进行手术切断。
