Variation of the vertebral artery bifurcation is rare. This branching abnormality can make it difficult to identify the recurrent laryngeal nerve (RLN) during thoracoscopic esophagectomy. There are a few reports on abnormal branching of the vertebral artery but none related to esophagectomy. We report the case together with the results of the evaluation of vertebral artery bifurcation and length in 50 patients with esophageal cancer in our hospital.
Thoracoscopic esophagectomy was performed on a 70-year-old patient with esophageal cancer. During lymph node dissection, an unusual blood vessel was found running along the right subclavian artery (RSA). This blood vessel made it difficult to identify the right RLN. We determined this blood vessel to be the right vertebral artery (RVA) branching far more centrally than usual. Because this anatomical abnormality was clarified, we could then recognize that the right RLN coursed around the RVA and the RSA and thus was running in a larger arch than usual.
Knowledge of such anatomical variation is important in thoracoscopic esophagectomy to prevent iatrogenic injury of the RLN and the vertebral artery.