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Войти в исследования The Journal of surgical research · 2026
Aberrant Right Subclavian Artery in Infants With Esophageal Atresia: A Single-Institution Study of Incidence and Outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Witte Amanda B, Lal Dave R, Schneider John G, Lerner Diana G, Maloney Caroline W
Аннотация
INTRODUCTION: Esophageal atresia (EA) is associated with aortic arch anomalies, including an aberrant right subclavian artery (ARSA) in 3.4-12%. ARSA complicates EA repair due to proximity to the esophageal anastomosis and poses risks during subsequent interventions for strictures. This study characterizes management, complications, and outcomes of EA patients with ARSA.
METHODS: Retrospective review (2012-2023) of EA patients with ARSA at a single institution. Data on diagnosis, management and complications were analyzed with descriptive statistics.
RESULTS: Among 128 EA patients, 12 (9.4%) had ARSA: EA with distal tracheoesophageal fistula (8/12), pure EA (2/12), EA with proximal tracheoesophageal fistula (1/12), H-type (1/12). ARSA was identified on echocardiogram in 7/12 (5/12 on initial postnatal echocardiogram), computed tomography angiography (3/12), and esophagram (2/12). Two patients underwent upfront ARSA ligation during initial EA repair without complication (mean follow-up 14 mo). Eight patients (67%) required esophageal dilation for strictures following esophago-esophagostomy. Three patients (25%) required stent placement for refractory strictures: one developed an esophago-ARSA fistula necessitating emergent ARSA ligation and reimplantation, one had occluded ARSA on subsequent imaging, and one had premature stent removal due to ARSA concerns. Ten ARSA patients (83%) diagnosed within last 5 y, suggesting improved echocardiographic detection.
CONCLUSIONS: ARSA can complicate EA repair and subsequent esophageal interventions, particularly stent placement for strictures. Improved awareness and routine echocardiographic screening enable preoperative planning. Larger studies are needed to establish optimal ARSA management in EA patients, especially those with long-gap EA requiring future interventions.
METHODS: Retrospective review (2012-2023) of EA patients with ARSA at a single institution. Data on diagnosis, management and complications were analyzed with descriptive statistics.
RESULTS: Among 128 EA patients, 12 (9.4%) had ARSA: EA with distal tracheoesophageal fistula (8/12), pure EA (2/12), EA with proximal tracheoesophageal fistula (1/12), H-type (1/12). ARSA was identified on echocardiogram in 7/12 (5/12 on initial postnatal echocardiogram), computed tomography angiography (3/12), and esophagram (2/12). Two patients underwent upfront ARSA ligation during initial EA repair without complication (mean follow-up 14 mo). Eight patients (67%) required esophageal dilation for strictures following esophago-esophagostomy. Three patients (25%) required stent placement for refractory strictures: one developed an esophago-ARSA fistula necessitating emergent ARSA ligation and reimplantation, one had occluded ARSA on subsequent imaging, and one had premature stent removal due to ARSA concerns. Ten ARSA patients (83%) diagnosed within last 5 y, suggesting improved echocardiographic detection.
CONCLUSIONS: ARSA can complicate EA repair and subsequent esophageal interventions, particularly stent placement for strictures. Improved awareness and routine echocardiographic screening enable preoperative planning. Larger studies are needed to establish optimal ARSA management in EA patients, especially those with long-gap EA requiring future interventions.