Dysphagia Aortica and Vascular Compression
Dysphagia aortica is a heterogeneous group of disorders that results from an aortic aneurysm(s) causing external compression of the esophagus and typically causing dysphagia. Etiologies of the aneurysms leading to dysphagia include atherosclerotic vascular disease, trauma, infections such as syphilis or fungus, and autoimmune diseases such as Takayasu arteritis. Most aneurysms causing dysphagia have been described in the descending aorta. Primary therapy is often directed toward the aneurysm and may include esophageal or aortic mobilization, stenting, and dilation. When the patient has significant cardiovascular risks, commonly associated with aneurysms, therapy is supportive, with dietary changes to soft solids and liquids. Notably, similar presentations may occur with esophageal compression from other vascular structures, such as a dilated right atrium in patients with chronic heart failure or mitral stenosis.
Another cause of esophageal vascular compression is dysphagia lusoria (freak of nature). There are two congenital conformations of dysphagia lusoria. In the first, a right subclavian artery located on the left side of the aortic arch crosses over behind the esophagus to supply the right upper extremity. The second type involves an aberrant left subclavian artery from the right side of the aorta that crosses left to right behind the aorta. Both make a transverse impression on the esophageal wall and can be confirmed by magnetic resonance or computed tomography angiography. In most patients, the abnormalities are found incidentally and the association with dysphagia is tenuous. In rare situations, surgery is needed.