From the Research
The cause of anterior tracheal pulsatile compression with loss of right radial pulse during scoping is an aberrant right subclavian artery, also known as arteria lusoria, as recently confirmed in a 2023 study 1. This is a congenital vascular anomaly where the right subclavian artery originates from the descending aorta distal to the left subclavian artery, rather than from the brachiocephalic trunk. The aberrant vessel typically courses behind the esophagus and trachea to reach the right arm, creating a vascular ring. During endoscopic procedures, the scope can compress this abnormal vessel against the trachea, temporarily occluding blood flow and causing the right radial pulse to disappear.
Key points to consider:
- This anatomical variant occurs in approximately 0.1-2.4% of the population, as noted in the 2023 study 1.
- It is usually asymptomatic but can present with dysphagia (dysphagia lusoria), respiratory symptoms, or rarely, vascular complications.
- Recognition of this anomaly is important during endoscopic procedures to understand the cause of these clinical findings and avoid potential complications.
- The 2023 study 1 highlights a simple method to diagnose arteria lusoria during right radial access coronary intervention, which can aid in early detection and management.
In terms of management, it is essential to be aware of this anomaly and its potential complications during endoscopic procedures. The 2020 study 2 discusses the treatment of an aberrant right subclavian artery occlusion using percutaneous vascular access, which may be relevant in some cases. However, the primary focus should be on recognizing and avoiding compression of the aberrant vessel during scoping procedures.