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Folia Morphologica 2021The vertebral artery originates from the subclavian artery and is divided into four segments. The aim of this study is to investigate the anatomical variations in the... (Review)
Review
BACKGROUND
The vertebral artery originates from the subclavian artery and is divided into four segments. The aim of this study is to investigate the anatomical variations in the course and branches of the vertebral artery.
MATERIALS AND METHODS
A research was performed via PubMed database, using the terms: "variations of vertebral artery AND cadaveric study", "variations of vertebral artery AND cadavers" and "anomalies of vertebral artery AND cadavers".
RESULTS
A total of 24 articles met the inclusion criteria, 13 of them referring to variations of the origin of the vertebral artery, 9 to variations of the course and 3 to variations of its branches. On a total sample of 1192 cadavers of different populations, origin of the left vertebral artery directly from the aortic arch was observed at 6.7%. In addition, among 311 cadavers, 17.4% were found with partially or fully ossified foramen of the atlas for the passage of the vertebral artery, while the bibliographic review also showed variants at the exit site of the artery from the transverse foramen of the axis.
CONCLUSIONS
Despite the fact that variations of both the course and the branches of vertebral artery are in most cases asymptomatic, good knowledge of anatomy and its variants is of particular importance for the prevention of vascular complications during surgical and radiological procedures in the cervix area.
Topics: Aorta, Thoracic; Cadaver; Embryonic Development; Female; Humans; Subclavian Artery; Vertebral Artery
PubMed: 32073130
DOI: 10.5603/FM.a2020.0022 -
Vascular and Endovascular Surgery Aug 2022New treatment options, like endovascular aortic repair, reduced the mortality rate of patients suffering from complications after an acute type A aortic dissection...
INTRODUCTION
New treatment options, like endovascular aortic repair, reduced the mortality rate of patients suffering from complications after an acute type A aortic dissection repair. Nevertheless, initial successful treatment of an aortic dissection does not fully eliminate the risk of later adverse aortic events like anastomotic pseudoaneurysm. Pseudoaneurysm of the anastomosis between the ascending and the arch graft could initiate complications like peripheral embolization, dysphagia or compression of mediastinum organs. Re-operation via re-sternotomy bears enormous morbidity and mortality for these patients. There is a high unmet need for percutaneous therapeutic options to treat pseudoaneurysms.
CASE PRESENTATION
A 59-year-old-man treated 15 years ago for type A aortic dissection, was hospitalized due to intermittent abdominal pain. A detailed examination revealed 2 pseudoaneurysms: 1 symptomatic at the level of the reimplanted celiac trunk and 1 asymptomatic at the anastomosis between the brachiocephalic trunk and the aortic arch graft. Due to multiple co-morbidities and previous operations, the risk for surgery was considered too high. Both pseudoaneurysm were treated percutaneously, the symptomatic 1 with covered stent and the asymptomatic with Amplatzer™ septal-occluder.
DISCUSSION
We present an alternative percutaneous therapy approach for treatment of pseudoaneurysm using a septal-occluder. A follow-up computed tomography 3 months later showed successfully excluded pseudoaneurysm.
Topics: Aortic Dissection; Aneurysm, False; Humans; Middle Aged; Septal Occluder Device; Stents; Treatment Outcome
PubMed: 35466833
DOI: 10.1177/15385744221095922 -
Neurointervention Mar 2022A male in his 60s presented with transient ischemic attacks 5 years after aortic arch branch graft repair for type A aortic dissection. Computed tomographic angiography...
A male in his 60s presented with transient ischemic attacks 5 years after aortic arch branch graft repair for type A aortic dissection. Computed tomographic angiography demonstrated 80% stenosis of the brachiocephalic artery close to the origins of the right common carotid and subclavian arteries. The case was reviewed at our multidisciplinary aortic meeting and a plan for endovascular management was made. Percutaneous endovascular Y stenting from the innominate artery into the left common carotid and subclavian arteries was achieved using self-expanding nitinol stents with a rendezvous technique that included retrograde right radial artery, retrograde right external carotid artery, and retrograde right femoral arterial approaches. At 6 months review, the stents remained widely patent and the patient was symptom-free.
PubMed: 35152617
DOI: 10.5469/neuroint.2021.00472 -
Irish Journal of Medical Science Aug 2023Many anatomical variations of the branching pattern of the aortic arch have been documented in the literature. These find their origin in alterations to the... (Review)
Review
BACKGROUND
Many anatomical variations of the branching pattern of the aortic arch have been documented in the literature. These find their origin in alterations to the embryological development of the arch and have significant implications for surgical and radiological interventions.
METHODS
Embase and Medline database searches were carried out in June 2021 and identified 1197 articles, of which 24 were considered eligible.
RESULTS
Twenty-eight variations were found. The prevalence of the six main variations found is as follows: normal configuration (61.2-92.59%); bovine arch type 1 (4.95-31.2%); bovine arch type 2 (0.04-24%); origin of left vertebral artery (0.17-15.3%); aberrant right subclavian artery (0.08-3.33%); thyroid ima artery (0.08-2%). Concomitant variations present in conjunction with these variations are also documented, as were other variations which could not be classified into these six groups.
CONCLUSIONS
Anatomical variations in the branching pattern of the aortic arch are present in over one-third of individuals in some populations. These are important pre- and intra-operatively during thoracic, neck and thyroid surgery. A greater effort should be employed to construct an official classification to facilitate greater understanding among clinicians.
Topics: Humans; Aorta, Thoracic; Subclavian Artery; Cardiovascular Abnormalities; Prevalence
PubMed: 36272028
DOI: 10.1007/s11845-022-03196-3 -
Diagnostics (Basel, Switzerland) Jan 2022Atherosclerosis, as a civilization disease, is a serious epidemiological problem. Significant carotid disease and significant coronary artery disease result in acute...
Atherosclerosis, as a civilization disease, is a serious epidemiological problem. Significant carotid disease and significant coronary artery disease result in acute consequences, such as ischemic stroke and myocardial infarction, which are the major causes of cardiovascular mortality. Typically, atherosclerosis of the aortic arch branches involves the bulbs of the common carotid arteries and the proximal segments of the internal carotid arteries, and can be effectively assessed by ultrasonography. Computed tomography angiography enables the identification of patients with less typical clinical manifestations of atherosclerosis, e.g., brachiocephalic trunk stenosis with symptoms of the steal syndrome and moderate stenosis in the coronary arteries. We present examples of computed tomography angiography images of this type of changes.
PubMed: 35054367
DOI: 10.3390/diagnostics12010200 -
Archiwum Medycyny Sadowej I Kryminologii 2016The paper presents a rare case of injury to the brachiocephalic trunk wall during percutaneous tracheotomy. The complication developed in a post-cardiac arrest patient...
The paper presents a rare case of injury to the brachiocephalic trunk wall during percutaneous tracheotomy. The complication developed in a post-cardiac arrest patient in a poor general condition. During hospitalization in the Intensive Care Unit, the patient suffered a haemorrhage directly from and around the endotracheal tube. After another episode of massive bleeding the patient died. The autopsy found that the source of the bleeding was injury to the brachiocephalic trunk.
Topics: Aged; Brachiocephalic Trunk; Critical Illness; Fatal Outcome; Humans; Intubation, Intratracheal; Male; Postoperative Hemorrhage; Respiration, Artificial; Tracheotomy
PubMed: 28677380
DOI: 10.5114/amsik.2016.68100 -
European Journal of Vascular and... Dec 2016
Topics: Aged; Aneurysm, False; Blood Vessel Prosthesis Implantation; Brachiocephalic Trunk; Computed Tomography Angiography; Humans; Male; Respiratory Tract Fistula; Tracheal Diseases; Tracheostomy; Vascular Fistula; Vascular System Injuries
PubMed: 27825809
DOI: 10.1016/j.ejvs.2016.10.005 -
The Journal of Veterinary Medical... Mar 2023In this study, we investigated the aortic arch (AA) branching pattern in the Eurasian otter (Lutra lutra). We performed arterial silicone casting of the AA of 18...
In this study, we investigated the aortic arch (AA) branching pattern in the Eurasian otter (Lutra lutra). We performed arterial silicone casting of the AA of 18 Eurasian otters (8 males and 10 females). We analyzed the AA branching pattern at three levels: the AA, brachiocephalic trunk (BCT), and subclavian artery (SB), using different classification methods at each level. We introduced new criteria for classifying the SB branching pattern applicable for Eurasian otter and other carnivores based on the sequence of the four main branches: vertebral artery (VT), internal thoracic artery (IT), costocervical artery (CCT), and superficial cervical artery (SC). In all Eurasian otters, two major branches emerged directly from the AA, i.e., the BCT and left SB. The BCT branched off the left common carotid artery and terminated in the right common carotid artery and right SB in 17 of 18 Eurasian otters; the BCT formed a bicarotid artery in the remaining case. The SBs showed various branching patterns, with the main branching pattern involving branching to the VT and IT at the same position, followed by the CCT and SC. The SB branching pattern in the Eurasian otter differed from that in dogs in that the two first branching arteries were VT and IT, rather than VT and CCT. Here, we present the anatomical characteristics of the AA branching patterns in the Eurasian otter and new analysis methods applicable for comparative studies of other carnivores.
Topics: Male; Female; Animals; Dogs; Otters; Aorta, Thoracic; Subclavian Artery; Mammary Arteries; Carotid Artery, Common
PubMed: 36792211
DOI: 10.1292/jvms.22-0517 -
Heliyon Dec 2022Multiple cardiovascular conditions can lead to unexpected fatality, which is defined as sudden cardiac death. One of these potentially underlying conditions is aortic...
INTRODUCTION
Multiple cardiovascular conditions can lead to unexpected fatality, which is defined as sudden cardiac death. One of these potentially underlying conditions is aortic regurgitation, which can be caused by discrete changes of the geometry of the proximal aorta. To analyze aortic valve competency and furthermore to elucidate underlying pathological alterations of the coronary arteries and the vasa vasorum a perfusion method to simulate a diastolic state was designed.
MATERIAL AND METHODS
A postmortem approach with retrograde perfusion of the ascending aorta with methylene blue was applied to three bodies. The procedure comprised cannulation of the brachiocephalic trunk, clamping of the aortic arch between brachiocephalic trunk and left carotid artery, infusion of 250 ml of methylene blue, and optical clearing of the superficial tissue layers after perfusion. Organs were examined directly following perfusion and after optical clearing.
RESULTS
Assessment and visualization of aortic valve competency and the vasa vasorum were possible in all three instances. Visualization of the coronary perfusion was impaired by postmortem thrombus formation. Optical clearing did not provide additional information.
DISCUSSION
The method presented here is a time- and cost-efficient way of visualizing aortic valve competency and the vasa vasorum. The visualization of the vasa vasorum highlights the potential of this method in basic research on diseases of the great arteries and coronaries. However, for a time-efficient functional analysis of the coronaries, other methods must be applied.
PubMed: 36636207
DOI: 10.1016/j.heliyon.2022.e12475