Michał Polguj

By Michał Polguj, Ludomir Stefańczyk and Mirosław Topol

The most common embryologic abnormality of the aortic arch is aberrant right subclavian artery (ARSA), known clinically as arteria lusoria (AL). This vessel travels to the right arm, crossing the middle line of the body and usually passing behind the esophagus. If the artery compresses the esophagus, it may produce a condition called dysphagia lusoria. Another commonly reported symptoms related to compression of adjacent structures by arteria lusoria were dyspnea, retrosternal pain, cough, and weight loss greater than 10 kg over a 6-month period. The chapter includes information describing demographic, clinical, and morphological characteristics of presence of arteria lusoria such as gender distribution, frequency in population, frequency of the most commonly reported symptoms related to compression of adjacent structures, coexistence with the most common vascular anomalies and diagnostic procedures. The presence of arteria lusoria together with the right nonrecurrent inferior laryngeal nerve (NRILN) is especially clinically important; during thyroid surgery, the right laryngeal nerve cannot be found at the lower pole of the thyroid, and it may be injured by the surgeon if it is not identified in the aberrant area or found lateral to the thyroid.

Part of the book: Epidemiology of Communicable and Non-Communicable Diseases

By Michał Polguj, Katarzyna Stefańczyk and Ludomir Stefańczyk

Four major variations of the venous system in the retroperitoneal space are the retroaortic left renal vein, left renal vein collar, left-sided inferior vena cava, and caval duplication. During surgery, especially, injury in veins is responsible for the most unexpected intraoperative bleeding. Therefore, above-mentioned anomalies pose potential hazards to surgeons during treatment of abdominal aortic aneurysm. Preoperative diagnosis is highly desirable but is not always available so, during abdominal surgery, familiarity with the anatomy of the most common types of venous variations is the first step toward preventing vascular injury. The chapter includes information describing the demographic, clinical, and morphological characteristics of the presence of the aforementioned main vein anomalies including: gender distribution, frequency in population, the most commonly reported symptoms, and associate complications. Massive intraoperative bleeding may be dangerous during aortic dissection; however, venous bleeding is more complicated than arterial hemorrhage. Significant venous bleeding, in particular, can occur if major retroperitoneal venous anomalies are present. The anomalous veins are typically thin-walled, dilated, and tortuous. As a result, manipulation of these veins during abdominal aortic surgery places the patient at high risk of long-term massive hemorrhage.

Part of the book: Aortic Aneurysm