Description, Causes and Risk Factors:
Bayford-Autenrieth dysphagia said to be due to compression by the aberrant right subclavian artery arising abnormally from the descending aorta and passing behind the esophagus.
Bayford-Autenrieth dysphagia is reportedly the result of esophageal compression by a congenital vascular anomaly. Vascular ring and aberrant right subclavian artery are terms describing the anomaly, which may have any aortic root origin and is most often described as an aberrant right subclavian artery traveling from the left side of the aortic arch and posterior to the esophagus, thus giving the appearance of a ring and causing a squeezing of the esophagus between the aortic arch and the anomalous artery.
The majority of cases of Bayford-Autenrieth dysphagia are due to ARSA causing posterior esophageal compression; yet only 20%-40% of aberrant arteries are thought to cause tracheo-esophageal symptoms including dysphagia. In patients who present at an advanced age, decreased vascular compliance is thought to be the most predominant factor; however the additional contribution of age-related esophageal dysmotility to their symptoms needs to be considered.
Symptoms of Bayford-Autenrieth dysphagia may occur at any age; it is not clear why some patients have dysphagia symptoms in infancy and others do not report symptoms until they are middle- or old-aged. Adults typically present with symptoms of dysphagia; infants more often present with respiratory symptoms. Researchers explained that this is so because in adults the esophagus is more apt to be compressed because the trachea is rigid. In infants the trachea is compressible; the typical sign and symptoms are respiratory, such as wheezing, stridor, recurrent pneumonia
, and cyanosis.
This condition is usually asymptomatic. Dysphagia is the most frequent presentation in adulthood. This isdue to extrinsic compression of this vessel on theposterior aspect of the thoracic esophagus. Other signs include esophageal dysmotility.
Diagnostic testing for Bayford-Autenrieth dysphagiawill vary accordingto patient complaints. Aberrant subclavian artery may be seen onroutine thoracic radiographs, thoracic angiograms, computedaxial tomography, or magnetic resonance imaging.In this particular case, a barium swallow was inconclusive.Aberrant subclavian artery was identified on computed axialtomography and confirmed by thoracic aortic angiogram. The aberrant subclavian artery on thoracic aorticangiogram. Clearly, the right subclavian artery is in a transposedposition coming off the left of the aortic arch.
Radiologic tests, angiogram CT, and magnetic resonanceimaging are the diagnostic tools used to identify this anomalyand to plan for patient care and management. Patients with anaberrant subclavian artery that is uncomplicated by aneurysm oraortic involvement can be successfully treated by operative repairwith a single supraclavicular approach.
Operative repair is the only treatment plan for a person with Bayford-Autenrieth dysphagia. The goal of operative repair is to relieve the dysphagia that is caused by the aberrant artery and to restore circulation. Restoration of normal circulation to the right arm is of utmost importance to prevent possible complications of claudication and subclavian steal syndrome. This is accomplished by anastomosis of the divided subclavian artery to the right common carotid artery or directly to the aortic arch with a prosthetic graft.
There is no standard approach to repair this anomaly. Right and left thoracotomies, cervical incision, median sternotomy, and combination approaches have been used. Thoracotomy is described as the traditional approach for re-implantation or proximal ligation of an aberrant artery; however, an extrathoracic approach has been used. In 1972, researchers described the aberrant right subclavian artery as most often coursing high in the mediastinum and being accessible through an incision in the cervical area.
For this patient, aberrant right subclavian artery was successfully repaired with a single supraclavicular incision. The subclavian artery was divided approximately 1 cm distal to the aortic arch. The proximal portion was oversewn and the distal portion anastomosed to the carotid artery.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.