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ascular ring in adult patients is a rare anomaly in which the aortic arch and its branches compress the trachea, esophagus, or both. We describe the case of a 73-year-old woman with dysphagia caused by com- pression by complete vascular ring. This is the oldest patient reported in the English-language literature in whom complete vascular ring detected and treated surgically. Clinical Summary A 73-year-old woman was noted to have dysphagia when she was hospitalized for mild cerebral infarction. During the hospitaliza- tion, she lost 5 kg body weight and reported dysphagia with intermittent substernal discomfort. There were no respiratory symptoms. Stenosis of the esophagus was suspected, and she was admitted to our department. An esophagogram revealed compression by a retroesophageal mass. Computed tomography (CT) with contrast agent revealed a double aortic arch that 3-dimensional (3D) CT indicated was a clear right aortic arch dominant-type complete vascular ring (Mayo Clinic classification type IA), in which the left common carotid and left subclavian arteries arose from the smaller left arch with mild calcification. The double arches were joined as the left descending aorta with Kommerell diverticulum (Figure 1).1 Other examinations produced no particular findings, such as congenital heart anomalies or esophageal tumor. The surgical approach used was through the fourth interspace rib with a fifth costotomy from a left posterolateral thoracotomy. The ligamentum arteriosum was divided after both aortic arches and the left subclavian artery, ligamentum arteriosum, and nerves had been dissected out completely (Figure 2). The left aortic arch was divided between clamps close to its junction with the descend- ing aorta, and its ends were closed with a continuous suture (4-0 polypropylene) with covering felt sheets. The Kommerell diver- ticulum was wrapped with the felt sheet, and this felt was sutured to the periosteum of an adjacent rib to retract the descending aorta laterally and posteriorly away from the esophagus. The operation was completed by closing the chest wound after insertion of a single intercostal drainage tube. After surgery, the patient recov- ered with no remarkable complications; she could consume solid foods and was gaining weight when she was discharged. Discussion Vascular rings are rare causes of dysphagia and dyspnea in adult patients. They represent a congenital anomaly that accounts for 1% to 2% of cases of congenital heart disease, in which the aortic arch and its branches completely or incompletely encircle and compress the trachea, esophagus, or both.2,3 This condition is mainly de - tected in infants or children with tracheoesophageal compressiv e syndromes, and curative management in this population has been described in many series. However, the management, surgical technique, and prognosis in adult patients with vascular rings causing symptoms have not been clarified. Symptomatic vascular

Detection and treatment of complete vascular ring in an elderly woman with dysphagia