Artery, Subclavian
The right subclavian artery usually shares a common origin with the right CCA called the brachiocephalic artery. However, it could originate directly from the aortic arch and be called lusorian artery (Case 1).
Pre-vertebral subclavian artery stenosis/occlusion can cause subclavian artery steal syndrome (Case 2).
Cases
1 Aberrant Right Subclavian Artery
1.1
CTA Neck
The aberrant right subclavian artery/lusorian artery (red arrow) which can be easily ascertained on CTA neck, is considered a relative contraindication for radial access.[1] Yellow arrow: right CCA. Blue arrow: left CCA. Green arrow: left subclavian artery. Orange arrow: right VA. Pink star: esophagus. White diamond: trachea. (Unfortunately, this is not an ideal study due to the suboptimal timing and contrast contamination in the adjacent veins.)
1.2
CTA Chest
This patient presented after a chest trauma. There is also an aberrant right subclavian artery (red arrow). Also, please note the right pulmonary contusion and the chest tube.
- Yellow arrow: Right CCA.
- Blue arrow: Left CCA.
- Green arrow: Left subclavian artery.
- Orange arrow: Right VA.
- Cyan arrow: Left VA.
- Black arrow: Right long thoracic artery.
- Magenta star: Esophagus/NGT.
- White diamond: Trachea/ETT.
1.3
This is an MRA neck of another patient who has an aberrant right subclavian artery.
- A and B: True AP view.
- C and D: LAO view.
- Red line: Aortic arch.
- Purple line: Right CCA.
- Green line: Left CCA.
- Pink line: Left subclavian artery.
- Black line: Left VA.
- Orange line: Right subclavian artery.
- Blue line: Right VA.
- White dotted line: Left subclavian vein.
1.4
- Yellow arrow: Right CCA.
- Green arrow: Left CCA.
- Red arrow: Left subclavian artery.
- White arrow: Left VA.
- Orange arrow: Aberrant right subclavian artery.
*The right VA is a small artery and is not shown.
1.5
An interesting observation from the 3D reconstruction of this aberrant right subclavian artery from the CTA is that the right VA originates from the right CCA (white arrow).
- Red arrow: right aberrant subclavian artery.
- Yellow arrow: Right CCA.
- Blue arrow: Left CCA.
- Green arrow: Left subclavian artery.
- Orange arrow: Right VA.
- Cyan arrow: Left VA.
2 Left Subclavian Artery Origin Occlusion
2.1
This patient was noticed to have discrepancy of the blood pressures on bilateral upper extremities. Intra-operative left subclavian artery and right vertebral artery angiographies revealed pre-vertebral occlusion of the left subclavian artery.
Occluded left subclavian artery with retrograde contrast flow into the aorta and left common carotid artery (arrow).
Right vertebral artery run in the same patient showed retrograde flow into the left vertebral artery and left subclavian artery. Notice there is also absence of bilateral posterior cerebral arteries due to bilateral fetal posterior communicating arteries.
2.2
This fluoroscopy demonstrated an occluded left subclavian artery origin (red arrow).
- White arrow: Right brachiocephalic artery.
- Orange arrow: Left common carotid artery.
Right VA injection showed retrograde flow into the left VA.