Embryology · Heart and vessels
Vascular rings and aberrant right subclavian artery !
- Malformation
Arch vessels that should vanish persist and wrap around the trachea and esophagus, which can cause noisy breathing or trouble swallowing.
Updated 2026-11-01
See it in 3D: Aortic arch · Subclavian artery · Recurrent laryngeal nerves · Esophagus · Trachea · Ligamentum arteriosum · Thoracic aorta
What it is
Vascular rings form when segments of the aortic arches or dorsal aortae that should regress persist, or the wrong ones regress. The result can fully or partly encircle the trachea and esophagus. The key ones are the double aortic arch, the right arch with an aberrant left subclavian, and the aberrant right subclavian artery.
Embryological cause
- Double arch: instead of regressing, the distal right dorsal aorta (between the 7th intersegmental artery and its junction with the left) persists.
- Aberrant right subclavian: the right 4th arch and proximal right dorsal aorta are obliterated; the subclavian is built from the distal right dorsal aorta and the 7th intersegmental artery.
- Right arch: the left dorsal aorta regresses instead of the right.
- All arise between weeks 6 and 8, during arch remodeling.
Markers
- 22q11.2 deletion
- TBX1
How it presents
- Infant: stridor, barking cough, wheeze, recurrent pneumonia, feeding difficulty.
- Older child or adult: dysphagia to solids (dysphagia lusoria).
- Many cases (especially an isolated aberrant subclavian) cause no symptoms.
Diagnosis
- Barium esophagram: posterior indentation of the esophagus.
- CT angiography or MRI define the ring before surgery.
- Fetal or postnatal echocardiography; bronchoscopy for tracheal compression.
Test yourself
Think of the answer, then tap the question to see it.
Which embryonic segment persists in a double aortic arch?
The distal right dorsal aorta, which normally disappears.
Why does an aberrant right subclavian artery run behind the esophagus?
The right 4th arch and proximal right dorsal aorta are obliterated; the subclavian arises from the distal right dorsal aorta, at the end of the arch.
What is dysphagia lusoria?
Difficulty swallowing from esophageal compression by an aberrant right subclavian artery.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
- Aortic arch
- Subclavian artery
- Recurrent laryngeal nerves
- Esophagus
- Trachea
- Ligamentum arteriosum
- Thoracic aorta
Related
- Aortic arch arteries and their derivatives
- Coarctation of the aorta
- 22q11.2 deletion (DiGeorge): the third and fourth pouches
- Fourth and sixth pharyngeal arches: the larynx and the vagus nerve
Related conditions
Educational content on embryonic development; not a guide to prenatal diagnosis or to medicines in pregnancy and no substitute for a health professional's advice. No doses are given.
Sources: Langman's Medical Embryology, 13th ed., ch. 13: Cardiovascular System (Wolters Kluwer, 2015); Vascular ring: MedlinePlus Medical Encyclopedia (National Library of Medicine (MedlinePlus), 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.