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Gailloud P. Vertebral arteria lusoria-Hyrtl's original description (1859), case illustration, and literature analysis. Surg Radiol Anat 2024; 46:1633-1642. [PMID: 39102042 DOI: 10.1007/s00276-024-03446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/23/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE A translation of the initial observation of vertebral arteria lusoria reported by Hyrtl in 1859 is followed by a review of all cases published until May 2023 to identify the anatomical and clinical features characterizing the typical form of this rare variant. METHODS PubMed, Google Scholar, and Google queries were performed with "vertebral arteria lusoria", "retroesophageal vertebral artery", and "aberrant vertebral artery" as keywords (in English, German, and French). A feature was considered typical when present in at least 75% of analyzed cases. A case of incidentally discovered vertebral arteria lusoria illustrates the typical form of the variant. RESULTS The analysis of 56 publications yielded 66 observations of right-sided vertebral arteria lusoria published between 1859 and May 2023. A small caliber, a retro-esophageal location, and passage through the foramen transversarium of C7 were typical. There was no evidence of association with clinical symptoms or other cardiovascular anomalies. CONCLUSION A typical vertebral arteria lusoria is an incidentally discovered nondominant aberrant right VA originating from the proximal descending aorta and following a retro-esophageal course to enter the C7 foramen transversarium, without associated aortic arch branching anomalies or congenital cardiovascular pathologies.
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Affiliation(s)
- Philippe Gailloud
- Interventional Neuroradiology, The Johns Hopkins Hospital, The Johns Hopkins University, 1800 E Orleans Street, Baltimore, MD, 21287, USA.
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Triantafyllou G, Melissanidis S, Vlychou M, Tsakotos G, Pantazis N, Vassiou K, Tsiouris C, Piagkou M. Right-Sided Aortic Arch: A Computed Tomography Angiography Investigation, A Systematic Review with Meta-Analysis. J Clin Med 2024; 13:3105. [PMID: 38892815 PMCID: PMC11172921 DOI: 10.3390/jcm13113105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: The right-sided aortic arch (RAA) is an uncommon variation of the aortic arch (AA), characterized by the aorta crossing over the right main bronchus. In the RAA, the descending aorta can be found on either the right or left side of the spine. The current study comprises a comprehensive retrospective computed tomography angiography (CTA) investigation into the prevalence of the RAA within the Greek population. Additionally, we will conduct a systematic review and meta-analysis to elucidate both common and rare morphological variants of the RAA. This research is significant as it sheds light on the prevalence and characteristics of the RAA in a specific population, providing valuable insights for clinical practice. Methods: Two hundred CTAs were meticulously investigated for the presence of a RAA. In addition, the PubMed, Google Scholar, and Scopus online databases were thoroughly searched for studies referring to the AA morphology. The R programming language and RStudio were used for the pooled prevalence meta-analysis, while several subgroup analyses were conducted. Results: Original study: A unique case of 200 CTAs (0.5%) was identified with an uncommon morphology. The following branches emanated from the RAA under the sequence: the right subclavian artery (RSA), the right common carotid artery (RCCA), the left common carotid artery (LCCA), and the left vertebral artery (LVA) in common origin with the aberrant left subclavian artery (ALSA). The ALSA originated from a diverticulum (of Kommerell) and followed a retroesophageal course. Systematic Review and Meta-Analysis: Sixty-two studies (72,187 total cases) met the inclusion criteria. The pooled prevalence of the RAA with a mirror-image morphology was estimated at 0.07%, and the RAA with an ALSA was estimated at <0.01%. Conclusions: AA anomalies, specifically the RAA, raise clinical interest due to their coexistence with developmental heart anomalies and possible interventional complications. Congenital heart anomalies, such as the Tetralogy of Fallot and patent foramen ovale, coexisted with RAA mirror-image morphology.
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Affiliation(s)
- George Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
| | | | - Marianna Vlychou
- Department of Radiology, University Hospital of Larissa, 413 34 Larissa, Greece;
| | - George Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian, University of Athens, 115 27 Athens, Greece;
| | - Katerina Vassiou
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 413 34 Larissa, Greece;
| | - Christos Tsiouris
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
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Shamsodini J, Molnár D. A Computed Tomography Study on the Prevalence of Lusorian Artery Among Hungarian Adults. Cureus 2024; 16:e58622. [PMID: 38770487 PMCID: PMC11103453 DOI: 10.7759/cureus.58622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The aberrant right subclavian artery (ARSA), also called as lusorian artery (LA) is a developmental anomaly that exists in conjunction with a right non-recurrent laryngeal nerve (NRLN) in almost all cases. The average prevalence of such a vascular variation is estimated as 1%, although, studies have reported very different population means. Up to date, there is no available data on the frequency of this pattern in the Hungarian population. It can be treated as an indirect marker of a NRLN. Any preoperative information on the course of the inferior laryngeal nerves can help surgeons reduce the risk of an iatrogenic injury during thyroidectomies, especially in an environment where access to intraoperative neuromonitoring is limited. Objectives The primary aims were to determine the prevalence of an ARSA, predict the existence of an NRLN in the Hungarian population, and provide demographic analysis. Methods A retrospective, computed tomography-based study was carried out. Demographic description and statistical analysis were provided where applicable. Detected anomalous vasculatures were visualized with 3D segmentation, and images were interpreted. Results The imaging database review identified three patients with ARSA out of 686 eligible recordings, resulting in a frequency of 0.437% in the study population. All three patients were female and had a retroesophageal LA. Two of them had a Kommerell's diverticulum. One patient had common carotid arteries with a single origin. Conclusions The frequency of an ARSA and a concomitant NRLN among Hungarians fits into the results of recent meta-analyses. Preoperative assessment of this anomaly may reduce vocal cord complication rates of thyroidectomies.
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Affiliation(s)
- Julia Shamsodini
- Department of Otolaryngology, Semmelweis University, Budapest, HUN
| | - Dávid Molnár
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, HUN
- Department of Otorhinolaryngology and Head and Neck Surgery, Central Hospital of Northern Pest - Military Hospital, Budapest, HUN
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Nedelcu AH, Lupu A, Moraru MC, Tarniceriu CC, Stan CI, Partene Vicoleanu SA, Haliciu AM, Statescu G, Ursaru M, Danielescu C, Ioniuc I, Tepordei RT, Lupu VV. Morphological Aspects of the Aberrant Right Subclavian Artery-A Systematic Review of the Literature. J Pers Med 2024; 14:335. [PMID: 38672962 PMCID: PMC11051064 DOI: 10.3390/jpm14040335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are incidental due to minimal clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients. MATERIALS AND METHODS We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery. RESULTS Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the "44 to 57 years" and "58 to 71 years" age ranges. CONCLUSIONS ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.
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Affiliation(s)
- Alin Horatiu Nedelcu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
- Radiology Clinic, Recovery Hospital, 700661 Iasi, Romania
| | - Ancuta Lupu
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
| | - Marius Constantin Moraru
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Cristina Claudia Tarniceriu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Cristinel Ionel Stan
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Simona Alice Partene Vicoleanu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Ana Maria Haliciu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Gabriel Statescu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Manuela Ursaru
- Department of Surgical Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (M.U.); (C.D.)
- Radiology Clinic, “Sf Spiridon” County Clinical Emergency Hospital Iasi, 700661 Iasi, Romania
| | - Ciprian Danielescu
- Department of Surgical Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (M.U.); (C.D.)
| | - Ileana Ioniuc
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
| | - Razvan Tudor Tepordei
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Vasile Valeriu Lupu
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
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Bunea MC, Rusali LM, Tudorache SI, Bratu IC, Bordei P. Considerations on the morphology of the thyroid ima artery. Surg Radiol Anat 2024; 46:91-99. [PMID: 37991506 DOI: 10.1007/s00276-023-03268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE AND BACKGROUND Detailed knowledge of the thyroid ima artery is essential for surgeons consequently we conducted an analysis investigating the arterial vasculature of the thyroid gland in 290 cases by dissection of formalin-fixed cadavers and by studying computed tomography angiographies. METHODS Our study was conducted on 82 cases obtained from the dissection of formalin-fixed cadavers while 208 cases were computed tomography angiographies. The following aspects were observed: the frequency of the thyroid ima artery, its origin, course, and diameter. All were studied, comparing right to left and according to sex. RESULTS Following the study of thyroid gland vasculature on a number of 290 cases, the thyroid ima artery was discovered in 16 cases (5.52% of cases), from which 3.45% of cases were in male subjects, and 2.07% of cases in female subjects. Of these, 4.14% of the total cases were left thyroid ima artery, and 1.38% of cases were on the right, found only in female subjects. In 5.17% of the total cases, the thyroid ima artery originated from the aortic arch, of which 3.45% were in the male sex and 1.72% were in the female sex. In one case only (0.35%) in the female sex did the thyroid ima artery originate from the brachiocephalic trunk. In 2.76% of cases, the thyroid ima artery existed with a left-sided inferior thyroid artery originating from the subclavian artery, either directly or from a thyrocervical trunk. CONCLUSIONS The thyroid ima artery has proven to be one of the highly variable arteries in terms of its presence and origin and the knowledge surrounding it is useful for surgical interventions.
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Gaydarski L, Angelov M, Tivcheva Y, Krastev N, Landzhov B. A Rare Case of Thyroidea Ima Arising From the Internal Thoracic Artery and Reaching Up to the Parathyroid Gland. Cureus 2023; 15:e49551. [PMID: 38156195 PMCID: PMC10753642 DOI: 10.7759/cureus.49551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
The thyroidea ima artery (TIA), also known as the Neubauer artery, is a variable artery that takes part in the blood supply of the thyroid gland. The overall prevalence rate of the thyroidea ima artery is 3.3%. Though it most commonly branches off the brachiocephalic trunk or the arch of the aorta, the artery has a highly variable origin point. Herein, we present a rare case of a thyroidea ima originating from the left internal thoracic artery, found during routine dissection of a Caucasian, 76-year-old, male, formalin-fixed cadaver. The artery is a normal finding during embryological development as a part of a more extensive network of vessels supplying the thyroid gland. The latter undergoes significant remodeling, and only four superior and inferior thyroid arteries remain. Thus, the presence of the thyroidea ima is considered to be due to changes in the said remodeling process. Due to its course, anteriorly to the trachea, the thyroidea ima artery might pose problems during different surgical procedures regarding the inner anterior region of the neck, such as tracheotomy, thyroidectomy, laryngeal transplantation, and selective embolization of the thyroid arteries (SETA). Furthermore, complications during the operative treatment of parathyroid conditions and mediastinal bleeding are to be expected. The variable presence and origin of the thyroidea ima have clear and significant clinical and surgical implications. They must be considered when procedures in the neck's anterior region occur.
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Affiliation(s)
- Lyubomir Gaydarski
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, Sofia, BGR
| | - Mihail Angelov
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, Sofia, BGR
| | - Yoanna Tivcheva
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, Sofia, BGR
| | - Nikolay Krastev
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, Sofia, BGR
| | - Boycho Landzhov
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, Sofia, BGR
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Boppana A, Lee S, Malhotra R, Halushka M, Gustilo KS, Quardokus EM, Herr BW, Börner K, Weber GM. Anatomical structures, cell types, and biomarkers of the healthy human blood vasculature. Sci Data 2023; 10:452. [PMID: 37468503 PMCID: PMC10356915 DOI: 10.1038/s41597-023-02018-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/30/2023] [Indexed: 07/21/2023] Open
Abstract
More than 150 scientists from 17 consortia are collaborating on an international project to build a Human Reference Atlas, which maps all 37 trillion cells in the healthy adult human body. The initial release of this atlas provided hierarchical lists of the anatomical structures, cell types, and biomarkers in 11 organs. Here, we describe the methods we used as part of this initiative to build the first open, computer-readable, and comprehensive database of the adult human blood vasculature, called the Human Reference Atlas-Vasculature Common Coordinate Framework (HRA-VCCF). It includes 993 vessels and their branching connections, 10 cell types, and 10 biomarkers. With this paper we are releasing additional details on vessel types and subtypes, branching sequence, anastomoses, portal systems, microvasculature, functional tissue units, mappings to regions vessels supply or drain, geometric properties of vessels, and links to 3D reference objects. Future versions will add variants and connections to the lymph vasculature; and, it will iteratively expand and improve the database as additional experimental data become available through the participating consortia.
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Affiliation(s)
| | - Sujin Lee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rajeev Malhotra
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marc Halushka
- Department of Pathology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Katherine S Gustilo
- Department of Intelligent Systems Engineering, Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, Indiana, USA
| | - Ellen M Quardokus
- Department of Intelligent Systems Engineering, Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, Indiana, USA
| | - Bruce W Herr
- Department of Intelligent Systems Engineering, Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, Indiana, USA
| | - Katy Börner
- Department of Intelligent Systems Engineering, Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, Indiana, USA
| | - Griffin M Weber
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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Totlis T, Natsis K, Achlatis V, Pettas T, Piagkou M. Thyroidea ima artery multiple branching pattern over the trachea. Surg Radiol Anat 2023:10.1007/s00276-023-03156-1. [PMID: 37106242 PMCID: PMC10317869 DOI: 10.1007/s00276-023-03156-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/21/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE The current cadaveric report describes a rare case of a thyroidea ima artery (TIA) with multiple branching pattern over the trachea. METHODS A cadaver dissection of the neck and thorax region of a formalin-embalmed 90-year-old male cadaver of a body donor took place. The body donation was made after a signed informed consent. RESULTS The TIA variant originated from the brachiocephalic artery before its bifurcation into the right common carotid artery (CCA) and right subclavian artery (SCA). TIA further divided into three anterior and two posterior branches, with subsequent multiple division into smaller branches. All branches were located anterior and right side to the trachea. The anterior branches supplied the infrahyoid muscles and the posterior ones supplied the thyroid gland inferior lobes and the inferior parathyroid glands. The TIA coexisted with a brachiocephalico-carotid trunk, derived after the left CCA and brachiocephalic artery fusion. CONCLUSION The presence of multiple arterial branches over the trachea creates a high risk for excessive bleeding during tracheotomy or cricothyroidotomy.
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Affiliation(s)
- T Totlis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - K Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Achlatis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Pettas
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Tasdemir R, Cihan ÖF, Ince R, Sevmez F. Anatomical Variations in Aortic Arch Branching Pattern: A Computed Tomography Angiography Study. Cureus 2023; 15:e36731. [PMID: 37123663 PMCID: PMC10131257 DOI: 10.7759/cureus.36731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Variations in the branching pattern of the aortic arch (AA) are common. Modification of intravascular stents should be considered taking into account these AA branching variations. Identification of supra-aortic branching types and frequencies is important for specialists planning surgery in this region. In endovascular interventions to the AA, aortic stent grafts should be modified according to the variations of the branching patterns of the AA. In any surgical intervention to the region where the supra-aortic branches are located, ignorance of the variations may cause unwanted injuries or complications. METHODS In this study, 699 computed tomography angiography (CTA) images were reviewed to investigate AA branching variations using the Horos software (an open-source image viewer). Four groups were constructed based on the number of branches emerging from the aortic arch, which were further divided into subtypes. RESULTS A total of 699 CTA images from 320 males and 379 females were included in this study. The usual AA branching pattern (type 3b1) was found in 68.5% of the patients. The combined prevalence of other eight branching patterns, designated as variations, was 31.5%. Variation types 1b1, 3b2, and 4b5 were identified in one patient each. Overall, types 2b1 and 2b2 had a prevalence of 28.3%. The type 2b3 variation was observed in 1.6% of the patients. The least common variations were type 4b1 (0.7%) and type 3b2 (0.1%). CONCLUSION The identification of variations in AA branching patterns by CTA prior to surgical or endovascular interventions involving the aortic arch is important. Thus, specialists planning interventions in this region need to be aware and have knowledge of atypical aortic branching patterns. Higher prevalence rates of AA branching patterns compared to previous studies were identified in the Turkish population in this study and therefore, a comprehensive, multicenter study is needed to determine the cause of this differential finding.
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Xue H, Zhang L, Yu A, Lin M, Guo Q, Xu L, Huang H. Prenatal genetic analysis of fetal aberrant right subclavian artery with or without additional ultrasound anomalies in a third level referral center. Sci Rep 2023; 13:3414. [PMID: 36854820 PMCID: PMC9975173 DOI: 10.1038/s41598-023-30598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
To evaluate the correlation between chromosomal abnormalities and fetal aberrant right subclavian artery (ARSA) with or without additional ultrasound anomalies (UAs). A total of 340 fetuses diagnosed with ARSA by ultrasound between December, 2015, and July, 2021, were included. All cases were subdivided into three groups: (A) 121 (35.6%) cases with isolated ARSA, (B) 91 (26.8%) cases with soft markers, and (C) 128 (37.6%) cases complicated with other UAs. Invasive testing was performed via amniotic fluid or cord blood karyotyping and chromosomal microarray analysis (CMA) in parallel, and pregnancy outcomes were followed. Karyotype abnormalities were identified in 18/340 (5.3%) patients. Karyotype abnormalities in Groups A, B, and C were 0/121 (0.0%), 7/91 (7.7%), and 11/128 (8.6%), respectively. CMA abnormalities with clinically significant variants were detected in 37/340 (10.9%) cases, of which 22q11.2 deletion syndrome and trisomy 21 accounted for 48.6% (18/37). The overall abnormal CMA with clinically significant variant detection rates in Groups A, B, and C were 3/121(2.5%), 13/91 (14.3%), and 21/128 (16.4%), respectively. There were significant difference in clinically significant CMA anomalies detection rate between Groups A and C (p < 0.05), as well as Groups A and B (p < 0.05). Comparing CMA to karyotyping showed a clinically significant incremental yield in Group C (7.8%, 10/128) compared to Groups A (2.5%, 3/121) and B (6.6%, 6/91) (p > 0.05). Fetal ARSA with additional UAs, concurred with cardiac and extra-cardiac anomalies, constitutes a high-risk factor for chromosomal aberrations, especially for pathogenic or likely pathogenic copy number variants.
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Affiliation(s)
- Huili Xue
- Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001, Fujian Province, China.
| | - Lin Zhang
- grid.256112.30000 0004 1797 9307Fujian Medical University, No. 88 Jiaotong Road, Cangshan District, Fuzhou City, 350001 Fujian Province China
| | - Aili Yu
- grid.256112.30000 0004 1797 9307Reproductive Medicine Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Min Lin
- grid.256112.30000 0004 1797 9307Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Qun Guo
- grid.256112.30000 0004 1797 9307Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Liangpu Xu
- grid.256112.30000 0004 1797 9307Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Hailong Huang
- grid.256112.30000 0004 1797 9307Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
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11
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Kopp J, Irshaid A, Baker J, Fitzsimmons J, Lin JC. Aberrant Right Subclavian Artery: Cadaver Case Report. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2023. [DOI: 10.5195/ijms.2022.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
While examining the anatomy of a cadaver in a medical school gross anatomy course, an aortic arch anomaly was discovered. This variant is consistent with an aberrant right subclavian artery (ARSA). In this variant the right subclavian artery branches from the most distal part of the aortic arch and runs both retrotracheal and retroesophageal as it courses to the right shoulder. This variant is a result of aberrant development of the aortic arch and may include presenting symptoms such as dysphagia and shortness of breath, if any at all. Additional to the ARSA exists a common bicarotid trunk and a direct branching of the left vertebral artery from the aortic arch, both of which are rare anomalies. The cadaver’s medical history includes dysphagia and stretched esophagus, although the severity is unknown. This case report draws attention to these rare anatomical anomalies and includes a discussion of the most common clinical presentation, and surgical implications of an aberrant right subclavian artery anomaly.
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12
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Keet K, Gunston G, Alexander R. A systematic classification of the left-sided aortic arch variants based on cadaveric studies' prevalence: response. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1251-1252. [PMID: 36056238 DOI: 10.1007/s00276-022-03014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Kerri Keet
- Division of Clinical Anatomy, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Geney Gunston
- Division of Clinical Anatomy and Biological Anthropology, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rachel Alexander
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
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Common carotid artery medialization and fracture dislocation of the cervical spine. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1073-1077. [PMID: 35857085 DOI: 10.1007/s00276-022-02965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/21/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To describe the management of the discovery of a retropharyngeal carotid artery in the context of a cervical dislocation. DESCRIPTION OF THE CASE A 68-year-old female presented acute neck pain and incomplete tetraplegia following a fall on the stairs. Radiographs, contrast-enhanced computed tomography scan and magnetic resonance of the cervical spine revealed a C5-C6 bi-articular dislocation. A detailed preoperative assessment of the images discovered a medialization of the left common carotid artery. An external reduction and a left anterior cervical approach allowed a careful management of the vascular variation and an anterior C5-C6 arthrodesis. At six months, a full neurological recovery was assessed and radiographs demonstrated successful fusion of the cervical arthrodesis. DISCUSSION/CONCLUSION Anatomical features such as medialization of the common carotid artery may affect patients with traumatic cervical spine injuries. The severity of the traumatic bone lesions should not overshadow the preoperative analysis of the adjacent anatomical structures encountered during the surgical approach, even in an emergency situation.
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14
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Downey PS, Thors A, Johnson P, Gupta K, Wallisch WJ, Almoghrabi O, Muehlebach GF, Zorn GL. Hybrid repair of acute type B dissection with aberrant right subclavian artery and bicarotid trunk. J Vasc Surg Cases Innov Tech 2022; 8:214-217. [PMID: 35493339 PMCID: PMC9048060 DOI: 10.1016/j.jvscit.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/04/2022] [Indexed: 11/29/2022] Open
Abstract
Patients with type B aortic dissection (TBAD) often present as an emergency. Operative repair of TBAD can be indicated for selected patients in the setting of hemodynamic instability or rupture. Thoracic endovascular aortic repair of TBAD has achieved significant popularity. Variant aortic arch anatomy can present a significant clinical challenge in patients with an inadequate proximal landing zone for thoracic endovascular aortic repair. A three-stage, hybrid aortic arch debranching and endovascular repair of a ruptured TBAD in a patient with a bicarotid trunk and an aberrant right subclavian artery was successfully performed using a unique technical approach.
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Tsiouris C, Lazaridis N, Piagkou M, Duparc F, Antonopoulos I, Antonitsis P, Natsis K. The left-sided aortic arch variants: prevalence meta-analysis of imaging studies. Surg Radiol Anat 2022; 44:673-688. [PMID: 35486163 DOI: 10.1007/s00276-022-02945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To estimate the prevalence of the left-sided aortic arch (LSAA) variants, and the effect of possible moderators on variants' detection. METHODS A systematic online literature search was conducted. The pooled prevalence with 95% confidence intervals was estimated for the typical and atypical branching patterns to compare the overall proportions of different variants. Meta-regression analyses were performed to investigate the effect of the subjects' gender and geographical region, and the multidetector computed tomography (MDCT) scanner's technology on the estimated prevalence. RESULTS In total, 18,075 cases from 23 imaging studies were included and 33 different LSAA variants were detected. The estimated heterogeneity was statistically significant. Based on the estimated prevalence, approximately 77% of the population is expected to have the typical branching anatomy with sequence brachiocephalic trunk-left common carotid artery-left subclavian artery, and 23% variant branching patterns. Approximately 71%, 23%, 2%, and 0.1% of the atypical populations are expected to have two, four, three, and five emerging branches, respectively. The meta-regression analyses showed that the number of detector rows of the MDCT scanner, and the subjects' geographical region are statistically significant moderators of the estimated prevalence. CONCLUSION The current findings indicate that the prevalence of the LSAA variant branching anatomy is significantly affected by the subjects' geographical region and the MDCT scanner's technological improvement, with the advanced scanners to facilitate the detection of the aortic arch variants. However, due to the heterogeneity among studies, further research is required.
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Affiliation(s)
- Christos Tsiouris
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Lazaridis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece.
| | - Maria Piagkou
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen-Normandy University, Rouen, France
| | - Ioannis Antonopoulos
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, AHEPA University General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece
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Pleș L, Cîrstoveanu C, Sima RM, Gorecki GP, Chicea R, Haj Hamoud B. Prenatal Diagnosis of Bovine Aortic Arch Anatomic Variant. Diagnostics (Basel) 2022; 12:diagnostics12030624. [PMID: 35328177 PMCID: PMC8947431 DOI: 10.3390/diagnostics12030624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Fetal aortic arch development is an early and complex process that depends on many genetic and environmental factors. The final aortic arch varies greatly; it may take the form of a normal arch, anatomic variant (AAAV) with a common origin to that of the innominate artery and left common carotid artery (formerly known as “bovine aortic arch” (with an incidence of up to 27%)) or one of multiple pathological conditions. The present study aimed to establish the feasibility and impact of prenatal anatomic arch variants’ diagnosis. A retrospective study of 271 fetal second- and third-trimester anomaly scans was performed in our tertiary center. Examinations that evaluated the sagittal aortic arch were included and the branching pattern was assessed. Additionally, a literature data search based on the terms “common origin of innominate artery and left common carotid artery”, “bovine arch”, “bovine aortic” and “aortic arch anomalies” was performed. Results that referred to prenatal AAAV were retained and the papers evaluated. In our study, the AAA incidence was 1.93%, with 4 out of 5 cases being arch type B. All cases had minor associated conditions but a good postnatal outcome. An anatomic aortic variant with a common IA and LCCa prenatal diagnosis was found in a small number of studies; most of the cases described in pediatric and adult series were related to cardiac surgery for stenting, aneurysm or thoracic-associated diseases. The incidence of AAAV varied from 6 to 27% depending on the population studied (highest incidence in African individuals). The variant was highly associated with aortic dissection, pulmonary and cerebral embolism and increased risks of incidents during surgery. Diagnosing AAAV during a routine anatomic scan is feasible and diagnoses can be made when anomaly scans are performed. Awareness of the condition is important for postnatal surgery when other cardiac anomalies are found; this can prevent accidents with simple changes to the patient’s lifestyle, and, in the case of surgery, means we can adopt the correct surgical approach.
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Affiliation(s)
- Liana Pleș
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- The “Bucur” Maternity, ‘Saint John’ Hospital, 040294 Bucharest, Romania
| | - Cătălin Cîrstoveanu
- Department of Pediatrics, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Pediatrics Department, ‘Maria Sklodowska Curie’ Emergency Children Clinical Hospital, 041451 Bucharest, Romania
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- The “Bucur” Maternity, ‘Saint John’ Hospital, 040294 Bucharest, Romania
- Correspondence: (R.-M.S.); (G.-P.G.)
| | - Gabriel-Petre Gorecki
- The “Bucur” Maternity, ‘Saint John’ Hospital, 040294 Bucharest, Romania
- Faculty of Medicine, ‘Titu Maiorescu’ University, 040441 Bucharest, Romania
- Correspondence: (R.-M.S.); (G.-P.G.)
| | - Radu Chicea
- Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550024 Sibiu, Romania;
| | - Bashar Haj Hamoud
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, 66421 Homburg, Germany;
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Stavridis K, Antsaklis P, Theodora M, Tasias K, Daskalakis G. Prenatal diagnosis of aberrant right subclavian artery: a literature review. J Matern Fetal Neonatal Med 2022; 35:8856-8862. [PMID: 35156496 DOI: 10.1080/14767058.2021.2005570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The primary aim of this review is to estimate the prevalence of ARSA both in euploid fetuses as well as in fetuses with Down Syndrome. Secondary objectives were to estimate the association of ARSA with cardiac anomalies and chromosomal defects, especially trisomy 21 and 22q11 deletion (DiGeorge Syndrome). The incidence of ARSA in normal population varies from 0.35% to 3.5%, based on different studies. Since the first reported association between ARSA and trisomy 21 in 2015 until today, several studies have emerged to confirm different degrees of this correlation. Indeed, ARSA appears to be a clinically useful prenatal ultrasound marker for trisomy 21. Particularly, most recent studies concluded that ARSA as a non-isolated finding can be used as screening for Down syndrome. However, when ARSA is an isolated finding, various studies proved that there is no significant correlation with Down syndrome. Apart from these, ARSA appears to be associated with other chromosomal abnormalities, such as 22q11 deletion, cardiac defects and other morphological anomalies. As a conclusion ARSA should be characterized as isolated or non-isolated, as the non - isolated ARSA appears to be a clinically useful marker of Down syndrome and thus, additional testing is required when diagnosed.
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Affiliation(s)
| | - Panos Antsaklis
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
| | - Marianna Theodora
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
| | - Konstantinos Tasias
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
| | - Georgios Daskalakis
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
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Açar G, Çiçekcibaşı AE, Uysal E, Koplay M. Anatomical variations of the aortic arch branching pattern using CT angiography: a proposal for a different morphological classification with clinical relevance. Anat Sci Int 2021; 97:65-78. [PMID: 34505990 DOI: 10.1007/s12565-021-00627-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/02/2021] [Indexed: 01/10/2023]
Abstract
The aortic arch (AA) branching pattern variations are usually asymptomatic, but they may lead to complications during cardiovascular procedures. In this retrospective study, we aimed to analyze the frequency of anatomical variations of the AA and to develop a different approach of morphological classification based on radiological criteria. 1026 computed tomography angiography scans of adults were evaluated and the presence of left-sided (LAA) and right-sided (RAA) AA were determined in 1023 (99.71%) and 3 (0.29%) of patients, respectively. According to the number of branches, LAA branching pattern of each patient was subclassifed in five morphological types. Based on the order and type-specific reference points, an anomalous LAA variants were classified into 20 subtypes. Type 1 (Typical branching pattern) LAA was identifed in 781 (76.12%) of the patients. Among 242 aberrant LAA variants (four types, 23.58%), the most common subtypes; Type 2A with brachiocephalico-carotid trunk (BCT), Type 4A1 with an aberrant left vertebral artery (ALVA), and Type 3A1, in which BCT coexisted with ALVA, were observed in 17.6%, 3.6%, and 0.88% of the cases, respectively. The frequency of remaining LAA variants ranged from 0.39% to 0.097%. In addition, Type 3B2 and Type 4C were first identified in our study. We observed Type I and II RAA in one female (0.097%) and two cases (male and female, 0.19%), respectively. Knowledge of AA branching variations is of great interest in neck and thoracic surgery and the new morphological types in clinically applicable form recommended in this study can be used in endovascular interventions.
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Affiliation(s)
- Gülay Açar
- Department of Anatomy, Meram Faculty of Medicine, Necmettin Erbakan University, Yunus Emre Mh. Unzile Sk, 42090, Meram, Konya, Turkey.
| | - Aynur Emine Çiçekcibaşı
- Department of Anatomy, Meram Faculty of Medicine, Necmettin Erbakan University, Yunus Emre Mh. Unzile Sk, 42090, Meram, Konya, Turkey
| | - Emine Uysal
- Department of Radiology, Faculty of Medicine, Selcuk University, 42075, Selçuklu, Konya, Turkey
| | - Mustafa Koplay
- Department of Radiology, Faculty of Medicine, Selcuk University, 42075, Selçuklu, Konya, Turkey
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Buffoli B, Verzeletti V, Hirtler L, Rezzani R, Rodella LF. Retroesophageal right subclavian artery associated with a bicarotid trunk and an ectopic origin of vertebral arteries. Surg Radiol Anat 2021; 43:1491-1495. [PMID: 33856505 PMCID: PMC8408090 DOI: 10.1007/s00276-021-02746-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
A rare branching pattern of the aortic arch in a female cadaver is reported. An aberrant right subclavian artery originated from the distal part of the aortic arch and following a retroesophageal course was recognized. Next to it, from the left to the right, the left subclavian artery and a short bicarotid trunk originating the left and the right common carotid artery were recognized. An unusual origin of the vertebral arteries was also identified. The left vertebral artery originated directly from the aortic arch, whereas the right vertebral artery originated directly from the right common carotid artery. Retroesophageal right subclavian artery associated with a bicarotid trunk and ectopic origin of vertebral arteries represents an exceptional and noteworthy case.
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Affiliation(s)
- Barbara Buffoli
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy. .,Interdepartmental University Center of Research "Adaption and Regeneration of Tissues and Organs (ARTO)", University of Brescia, Brescia, Italy.
| | - Vincenzo Verzeletti
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Rita Rezzani
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy.,Interdepartmental University Center of Research "Adaption and Regeneration of Tissues and Organs (ARTO)", University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy.,Interdepartmental University Center of Research "Adaption and Regeneration of Tissues and Organs (ARTO)", University of Brescia, Brescia, Italy
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