[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Embryology](https://durgical.com/en/embryology/) › [Heart and vessels](https://durgical.com/en/embryology/#a-heart) › Vascular rings and aberrant right subclavian artery [Embryology](https://durgical.com/en/embryology/) · [Heart and vessels](https://durgical.com/en/embryology/#a-heart) # 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](https://durgical.com/en/anatomy/aortic-arch/) · [Subclavian artery](https://durgical.com/en/anatomy/right-subclavian-artery/) · [Recurrent laryngeal nerves](https://durgical.com/en/anatomy/recurrent-laryngeal-nerve/) · [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/) · [Trachea](https://durgical.com/en/anatomy/trachea/) · [Ligamentum arteriosum](https://durgical.com/en/anatomy/ligamentum-arteriosum/) · [Thoracic aorta](https://durgical.com/en/anatomy/thoracic-aorta/) ## Key points - Double aortic arch: the distal right dorsal aorta persists; a complete ring; the most common symptomatic ring. - Right arch with aberrant left subclavian and a left ligamentum arteriosum: a complete ring. - Aberrant right subclavian: the right 4th arch is obliterated; the subclavian arises at the end of the arch and runs behind the esophagus. - Dysphagia lusoria: trouble swallowing from compression by the aberrant subclavian. - With an aberrant right subclavian the right laryngeal nerve is non-recurrent. - Associated with 22q11.2 deletion (right arch, interrupted arch). ## 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. ## Memory aid Keep the side that was meant to go, and the arch closes like a collar around the trachea and esophagus. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/embryology/vascular-rings-and-aberrant-right-subclavian-artery/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Aortic arch](https://durgical.com/en/anatomy/aortic-arch/) - [Subclavian artery](https://durgical.com/en/anatomy/right-subclavian-artery/) - [Recurrent laryngeal nerves](https://durgical.com/en/anatomy/recurrent-laryngeal-nerve/) - [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/) - [Trachea](https://durgical.com/en/anatomy/trachea/) - [Ligamentum arteriosum](https://durgical.com/en/anatomy/ligamentum-arteriosum/) - [Thoracic aorta](https://durgical.com/en/anatomy/thoracic-aorta/) ## Related - [Aortic arch arteries and their derivatives](https://durgical.com/en/embryology/aortic-arch-arteries-and-their-derivatives/) - [Coarctation of the aorta](https://durgical.com/en/embryology/coarctation-of-the-aorta/) - [22q11.2 deletion (DiGeorge): the third and fourth pouches](https://durgical.com/en/embryology/22q11-2-deletion-the-third-and-fourth-pouches/) - [Fourth and sixth pharyngeal arches: the larynx and the vagus nerve](https://durgical.com/en/embryology/fourth-and-sixth-pharyngeal-arches-the-larynx-and-the-vagus-nerve/) ## Related conditions - [DiGeorge syndrome (22q11.2 deletion syndrome)](https://durgical.com/en/conditions/digeorge-syndrome/) [← All of embryology](https://durgical.com/en/embryology/) 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](https://medlineplus.gov/ency/article/007318.htm) (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. --- Source: https://durgical.com/en/embryology/vascular-rings-and-aberrant-right-subclavian-artery/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/embryology/vascular-rings-and-aberrant-right-subclavian-artery/