A modified extrathoracic approach to the treatment of dysphagia lusoria

The management of patients with esophageal compression by an anomalous right subclavian artery (dysphagia lusoria) has been controversial. A classic approach involves left thoracotomy, with resection of the aberrant subclavian artery from its origin to the right border of the esophagus. To prevent possible ischemic complications, most surgeons favor revascularization of the distal subclavian artery. Thoracotomy has been the traditional approach for division or reimplantation of the aberrant right subclavian artery. We describe a modification (right supraclavicular incision) of an extrathoracic approach, which was first described by Orvald in 1972, to simplify simultaneous correction of dysphagia lusoria and revascularization of the right upper extremity.