Abbott's artery

Abbott's artery, also known as the arteria lusoria, is an anatomical variant of the arterial system that represents an aberrant or anomalous origin of the right subclavian artery. This condition is significant due to its implications in various medical and surgical contexts. The artery typically arises from the aorta distal to the left subclavian artery, coursing behind the esophagus to reach the right upper limb, which can lead to symptomatic compression of the esophagus or the trachea, a condition known as dysphagia lusoria.

Anatomy and Physiology

In a typical arterial configuration, the right subclavian artery branches off the brachiocephalic trunk, which is the first branch of the aortic arch. However, in the case of Abbott's artery, the right subclavian artery originates directly from the aorta, making it the last branch of the aortic arch. This aberrant artery then travels posterior to the esophagus, between the esophagus and the spinal column, or, less commonly, between the esophagus and the trachea. This anatomical variation can lead to a range of clinical manifestations, from being completely asymptomatic to causing significant esophageal or tracheal compression.

Clinical Significance

The presence of Abbott's artery is of particular interest in the fields of cardiology, thoracic surgery, and gastroenterology. It is often discovered incidentally during imaging studies for unrelated reasons. However, when symptomatic, patients may present with dysphagia, chronic cough, or respiratory distress, particularly in children. The diagnosis is typically confirmed through imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the chest, which can visualize the aberrant path of the artery.

Management

The management of Abbott's artery depends on the severity of symptoms. Asymptomatic individuals usually require no treatment. For those with significant symptoms, surgical intervention may be necessary. Surgical options include repositioning of the artery to relieve compression or the use of vascular grafts to reroute blood flow. Endovascular techniques, such as stenting, have also been explored as a less invasive alternative to open surgery.

Epidemiology

Abbott's artery is a rare anatomical variant, with its prevalence reported to be less than 2% in the general population. It is often associated with other congenital anomalies, including various forms of aortic arch anomalies and heart defects.

History

The condition was first described by Dr. Maude Abbott in 1915, who noted its association with congenital heart disease. Since then, the understanding of its clinical implications and management strategies has evolved significantly.

Conclusion

Abbott's artery is a rare but clinically significant anatomical variant that can lead to symptomatic compression of the esophagus and trachea. Awareness of this condition is crucial for healthcare professionals, as it can impact the approach to thoracic and cardiovascular surgeries and interventions. With advances in imaging and surgical techniques, patients with symptomatic Abbott's artery have a favorable prognosis.