Aberrant Right Subclavian Artery

Overview

An aberrant right subclavian artery is an unusual arrangement of a blood vessel that branches off the part of the body's largest artery called the aorta. In most people, the right subclavian artery starts from a blood vessel on the right side. In this condition, it starts from the left side and often passes behind the swallowing tube (esophagus). For many people, this causes no problems at all. For others, it can press on the esophagus or windpipe and cause symptoms like difficulty swallowing or breathing.

This is a fairly common blood vessel variation. Studies suggest it may occur in about 1 in every 200 to 1 in every 400 people. However, because most people have no symptoms, it is often only found when a CT scan or MRI is done for another reason.

It is a condition people are born with, so it can affect anyone. It is slightly more common in males and females equally, and it may be more likely in people with certain congenital heart conditions. Many people live their whole lives without any symptoms or health problems from it.

Symptoms

Common symptoms

• No symptoms at all (the most common experience).
• Occasional difficulty swallowing, especially when eating quickly.
• A feeling that food gets stuck in the chest.
• Mild chest discomfort or a heavy feeling after eating.
• A persistent, unexplained cough.

Symptoms in children

• Feeding difficulties in infancy, such as choking, gagging, or spitting up.
• Trouble gaining weight.
• Noisy breathing, wheezing, or frequent respiratory infections.
• Vomiting after feedings.
• Difficulty breathing or a bluish tint around the lips (rare, but serious).

Symptoms in older adults

• Difficulty swallowing solids more than liquids.
• Heartburn or acid reflux symptoms that are hard to control.
• Chest pain or discomfort, especially after meals.
• A cough that does not go away.
• Shortness of breath when lying flat or bending over.

Causes

Main causes

• A change in the way the arteries form in the womb during early pregnancy.
• The right subclavian artery develops from a different part of the fetal blood system than usual, so it ends up on the left side and may pass behind the esophagus.
• It is not caused by anything you did, ate, or avoided during pregnancy.

Risk factors

• Having another congenital (present at birth) heart condition.
• Having certain genetic conditions, such as Down syndrome, which make this blood vessel variation more likely.
• Being born with other differences in the chest organs, though this is uncommon.

When to see a doctor

See a doctor urgently if:

• If you have new or worsening trouble swallowing that affects eating and drinking.
• If you have chest pain or discomfort that is not going away.
• If you have a persistent cough with difficulty breathing.
• If a child has feeding problems, poor weight gain, or unusual breathing sounds.

Book a routine appointment if:

• If you or your child has occasional swallowing problems, heartburn, or a feeling that food sticks in the chest.
• If you were told you have this condition during an unrelated scan and are worried about it.
• If symptoms like a cough or chest fullness are starting to affect your daily life.

Diagnosis

Health care providers usually find this condition by accident when doing imaging tests for other reasons, such as after a chest injury, heart evaluation, or a CT scan for another symptom. If a doctor suspects it because of swallowing or breathing symptoms, they can order a specific test to look at the chest arteries and the esophagus.

Tests that may be done

• Chest X-ray – often the first test that hints at the condition.
• Barium swallow – a drink of a chalky liquid coats the esophagus and makes swallowing problems easier to see.
• CT scan or MRI – provide detailed pictures of the blood vessels and can confirm the abnormal route of the artery.
• Echocardiogram – an ultrasound of the heart may sometimes show the artery, especially in children.
• Endoscopy – a thin flexible tube with a camera may be used to check for other causes of swallowing problems.

What to expect at your appointment

If you are having tests, you don't need to worry. These are painless or minimally uncomfortable procedures. You may be asked not to eat or drink for a few hours before some tests and to take off metal objects like jewelry. The scan or procedure itself often takes less than an hour. Afterward, you can usually go home the same day unless more tests are needed.

Treatment

Treatment depends entirely on whether the artery is pressing on the esophagus or windpipe and whether it is causing symptoms. The vast majority of people need no treatment at all. For people who do have symptoms, there are simple steps and medical options that can make a big difference. Only a small number of people need surgery.

Self-care at home

• Eat slowly and chew food well to help avoid food sticking in the chest.
• Take smaller bites and smaller sips of fluids.
• Sit upright while eating and for a while after meals.
• Soft, moist foods may be easier to swallow than dry, scratchy ones.
• Avoid very hot or very cold drinks that may irritate the esophagus.
• If you have heartburn, try to avoid foods that make it worse, such as spicy or fried foods, caffeine, and mint.

Medical treatments

For mild symptoms, your doctor might suggest medicines that help with acid reflux or relax the muscle at the end of the esophagus. These are only general options, not specific recommendations — always ask your doctor or pharmacist what is safe and right for you. The main treatment is watching your symptoms and checking in with your health care team. If symptoms are caused by severe compression, the only real solution is surgery, and medicines alone will not fix the artery's position.

When is surgery considered?

Surgery is considered when the vessel is pressing firmly on the swallowing tube or windpipe and causing severe symptoms that affect eating, breathing, or daily life. The typical operation repositions the artery to a more normal line so it no longer presses on the esophagus. Your specialist team will decide if surgery is needed, and they will talk you through the benefits and risks before any procedure.

Living with this condition

For most people, this condition does not change daily life. You may not even know it is there. If you do have mild symptoms, small adjustments to how you eat and drink can make things much easier. You should also keep up with regular GP visits and let your doctor know if symptoms change.

Lifestyle tips

• Eat at a relaxed pace and don't rush meals.
• Avoid lying down immediately after eating.
• Keep a healthy weight to reduce pressure on the chest and abdomen.
• Stop smoking, because smoking irritates the esophagus and worsens reflux.
• Drink enough fluids so food moves through the esophagus more easily.

Diet and exercise

There is no specific diet that fixes this condition, but eating soft, well-chewed food and drinking water with meals can help with swallowing. Regular gentle exercise is good for overall health and does not harm the condition. If certain foods trigger heartburn or discomfort, keep a simple food diary to see what bothers you and mention this to your doctor.

Mental health and emotional wellbeing

Being told you have an unusual blood vessel can feel worrying, especially if you had no symptoms and it was found by chance. It is natural to wonder about risks. Try to remember that most people with this condition live normal, healthy lives. If you feel anxious or stressed about your health, talk to your GP or another trusted health care professional. You do not have to carry concerns alone.

Prevention

No, this is not something that can be prevented. It is a variation in how the arteries develop before birth, and it is not caused by anything you did or did not do. Because it is usually harmless and often symptom-free, there is nothing you need to do to prevent it. The main goal is simply to seek advice if symptoms ever affect your daily life.

Vaccines

Not applicable – this condition is not an infection and there is no vaccine for it. Keeping up to date with routine vaccinations is still a good idea for everyone to stay generally healthy.

Screening programmes

No routine screening test is recommended for this condition in the general population. It is most often discovered when imaging is done for another reason. If someone has swallowing or breathing symptoms, a doctor can arrange the right tests.

Complications

If left untreated

• Difficulty swallowing that may lead to poor nutrition or dehydration if severe.
• In children, failure to gain weight or delayed growth.
• Aspiration – food or fluid accidentally going into the windpipe, which can cause pneumonia.
• In very rare cases, the abnormal artery can develop a weak area (aneurysm) or a tear, but this is extremely uncommon.
• Esophageal inflammation or irritation from long-term reflux.

Long-term outlook

The outlook is very positive. For most people, an aberrant right subclavian artery is an incidental finding that never causes any health problem. Even for those who do experience symptoms, treatments — including surgery when necessary — are very effective. With the right care, most people can eat, breathe, and live normally.

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