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.
