Abstract

Dysphagia lusoria is rare embryologic defect of the aortic arch vasculature characterized by an aberrant retro-esophageal course of the right subclavian artery (RSA), comprising a vascular sling. This may manifest clinically with symptoms of dysphagia or reflux. Given the rarity of this pathology, there remains uncertainty regarding the most effective treatment algorithm. Vascular decompression procedure surgery is often used to rectify the aberrant vascular morphology. However, a low percentage of aberrant arteries result in trachea-esophageal symptoms. As such, we suggest (1) one must exclude co-morbid esophageal motility disorders in patients with dysphagia; and (2) aberrant RSA may be a cause of dysphagia, so-called dysphagia lusoria, but represents an unlikely mechanism, since this morphological arrangement typically does not result in a highly constrictive, circumferential vascular ring. It follows, therefore, that directly addressing the esophageal motility issue should take precedence over complex and potentially noncurative vascular procedures directed to the aberrant RSA. However, the presence of marked aneursymal dilation of the aberrant RSA, and/or the presence of a bicarotid (socalled bovine) trunk, would favor vascular repair in the clinical decision-making due to the elevated risk of rupture and more severe esophageal compression in these specific situations.

中文翻译：

---

吞咽困难：运动障碍的连接是虚假的还是真实的？

摘要

吞咽困难是主动脉弓脉管系统的罕见胚胎学缺陷，其特征在于右锁骨下动脉（RSA）的异常食管后段，包括血管吊带。这可能在临床上表现为吞咽困难或反流症状。鉴于这种病理的稀有性，关于最有效的治疗算法仍存在不确定性。血管减压手术通常用于矫正异常的血管形态。但是，低比例的动脉异常会导致气管食管症状。因此，我们建议（1）吞咽困难的患者必须排除共病性食管运动障碍；（2）异常的RSA可能是导致吞咽困难的原因，即所谓的吞尿困难，但代表了一种不太可能的机制，因为这种形态排列通常不会导致高度收缩的圆周血管环。因此，因此，直接解决食管动力问题应优先于针对异常RSA的复杂且潜在的非治愈性血管手术。然而，由于破裂的风险增加和食管受压更严重，异常RSA的明显的动脉瘤扩张和/或双歧（所谓的牛）躯干的存在将有利于临床决策中的血管修复。这些具体情况。