Aberrant Left Vertebral Artery Research Articles

ОПИСАНИЕ РЕДКОГО СЛУЧАЯ ОТХОЖДЕНИЯ АБЕРРАНТНОЙ ЛЕВОЙ ПОЗВОНОЧНОЙ АРТЕРИИ ОТ ДУГИ АОРТЫ С МОРФОМЕТРИЧЕСКИМ АНАЛИЗОМ БРАХИОЦЕФАЛЬНЫХ АРТЕРИЙ

Individual variability or variant anatomy is most common in blood vessels, among which brachiocephalic arteries should be distinguished. The article presents a case of the detection of one of these variations – an aberrant left vertebral artery branching off from the aortic arch in a 68-year-old patient. This artery was identified in him after a CT scan of the aortic arch and brachiocephalic arteries for pronounced vertebral-basilar insufficiency. In studying the angiogram, the authors carried out a morphometric analysis of all arteries branching off from the aortic arch.

Chyle leak after transposition of the aberrant left vertebral artery via 1-debranching thoracic endovascular aortic repair: a case report

BackgroundAlthough the transposition of the aberrant left vertebral artery (ALVA) in 1-debranching thoracic endovascular aortic repair requiring zone 2 coverage for thoracic aneurysm with ALVA is reported to be an effective option, there are few reports of complications associated with the transposition of the ALVA.Case presentationAn 87-year-old man underwent 1-debranching thoracic endovascular repair for a saccular thoracic aortic aneurysm with the aberrant left vertebral artery. Simultaneously, the transposition of the ALVA was performed to prevent cerebral complications because the left vertebral artery was dominant. Postoperative computed tomography revealed the reconstructed vertebral artery and no endoleak. However, a postoperative chyle leak occurred and was treated with lymphangiography.ConclusionAlthough the ALVA transposition is one of the better options, a chyle leak should be considered a serious complication of the procedure.

Transposition of left subclavian artery with reimplantation of isolated left vertebral artery before thoracic endovascular aneurysm repair for type B aortic dissection.

Understanding and recognizing anatomic anomalies of the aortic arch is important when planning extra-anatomic debranching before thoracic endovascular aortic repair. A rare anomaly is the left vertebral artery aberrantly arising from the aortic arch; found in ∼5% of adults. When present, the artery courses through the carotid sheath at a variable length before entering the third or fourth cervical transverse foramen. In the present report, we have described the case of a 49-year-old man with a symptomatic, enlarging type B aortic dissection with an aberrant left vertebral artery and the novel methods used to surgically correct his pathology.

Anatomical variations of the aortic arch branching pattern using CT angiography: a proposal for a different morphological classification with clinical relevance.

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.

A systematic classification of the left-sided aortic arch variants based on cadaveric studies' prevalence.

Typical branching pattern of the left-sided aortic arch consists of the brachiocephalic trunk (BCT), the left common carotid artery (LCCA) and the left subclavian artery (LSA). Variant patterns have been associated with a broad spectrum of pathologies. The meticulous knowledge of potential aortic arch variants is of utmost importance to radiologists, interventional cardiologists, vascular and thoracic surgeons. The current systematic review collects all aortic arch branching patterns and their frequency as published by various cadaveric studies, calculates prevalence taking into account the gender and the different people background, as well. All extracted variant patterns are classified into types and subtypes according to the number of emerging (major and minor) branches (1, 2, 3, 4 and 5) and to the prevalence they appear. In cases of similar prevalence, total cases were taken into consideration; otherwise the variants were classified under the title "other rare variants". A systematic online search of PubMed and Google books databases was performed only in cadaveric studies. Twenty studies with typical (78% prevalence) and variable (22%) branching patterns were included. Types 3b, 2b, 4b, 1b and 5b had aprevalence of81%, of13%, of5%, 0% and of0%, respectively. Common variants were the brachiocephalico-carotid trunk (BCCT, 49% prevalence), the aberrant left vertebral artery (LVA, 41%) and the aberrant right subclavian artery (ARSA, 8%). LVA of aortic origin was detected in 32%, the bicarotid trunk (biCT) in 5% and the bi-BCT trunk in 3%. Thyroidea ima artery, a minor branch emerging from the aortic arch was found in 2%. Coexisted variants were detected in 4% (ARSA with a distinct RCCA and LCCA origin), in 3% (BCCT with a LVA of aortic origin), in 2% (ARSA with a biCT and a vertebrosubclavian trunk). No significant gender or ethnic differences exist among the 5 branching types. The proposed classification scheme aims to become a valuable and easy to use tool in the hands of all physicians involved in diagnosis and treatment of aortic arch pathology. It could be also useful in anatomical education,as well.

Type B aortic dissection repair using a Thoraflex hybrid prosthesis in a setting of aberrant left vertebral artery

AbstractType B aortic dissection (TBAD) is often managed conservatively with intervention reserved for complicated cases. Strategies for complicated and uncomplicated TBAD can involve optimal medical therapy, thoracic endovascular aortic replacement and open surgical repair of TBAD with replacement of the affected segment of aorta and reimplantation of aortic branches. The frozen elephant trunk technique has been reported to be a successful surgical strategy in patients with complicated TBAD, particularly in patients who possess unfavourable aortic arch anatomy for endovascular stenting or at increased risk of retrograde Type A aortic dissection. The Thoraflex is a commercially available aortic graft, manufactured by Vascutek®. We describe a successful case of addressing complicated TBAD with rare variant aortic anatomy using a Thoraflex hybrid frozen elephant trunk graft and reimplantation of the aberrant left vertebral artery to the perfusion limb of the Thoraflex graft.

Rare Case of a Five‐Branched Aortic Arch Exhibiting a Retroesophageal Right Subclavian Artery and an Accessory Left Vertebral Artery

Head and neck vascular variations are common in human beings, but often go undetected. They are generally asymptomatic. Awareness of such anatomical variations is clinically important for surgeons and interventional radiologists as they may pose risk for iatrogenic complications or even the potential for unanticipated fatalities.Although aortic arch variations are relatively common in human fetuses, variations of its branches, i.e. the brachiocephalic trunk, the subclavian arteries, the vertebral arteries, and the common carotid arteries, are observed and/or described variably and fairly infrequently during human cadaveric dissection.When aberrant subclavian arteries are described in adults, they frequently involve the right side and are usually retroesophageal. In such cases, the right brachiocephalic trunk is absent. The following four branches of the aortic arch found most commonly then are: a left subclavian artery, an aberrant left vertebral artery, and right and left common carotid arteries. During cadaveric dissection of a 76 year‐old White male, we observed an additional fifth branch: an accessory left vertebral artery. A combination of five such aortic arch vessels in a single individual may be rare.Disclaimer: The opinions or assertions contained herein are the private ones of the author/speaker and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Clinically-relevant morphometric parameters and anatomical variations of the aortic arch branching pattern.

The ever expanding advances in various domains of cardiac and endovascular interventions has drawn tremendous attention toward the importance of the anatomical variability and morphometric parameters of the aortic arch (AA) and its branches. The current study delineates the morphometry and anatomical variations of the AA branches by evaluating coronal, axial and sagittal CT multiplanar reformatted three-dimensional angiograms. Correlations between morphometric data as well as the distribution of morphometric data in relation to the anatomical variations were also illustrated. 35% of the examined AA showed abnormal branching patterns, the most common of which was the "bovine arch" (24%), followed by common ostium variant (6%) and aberrant left vertebral artery arising directly from AA (5%). The outer diameter of AA at its origin and its end was 33.83 and 22.06mm, respectively. The distance between the origin of AA and the origin of brachiocephalic trunk (BCT), left common carotid artery (LCCA) and left subclavian artery (LSA) was 19.59, 23.01 and 26.01mm, respectively. The outer diameter of BCT, LCCA and LSA was 15.7, 11.42 and 14.02mm, respectively. The angles between the AA and the BCT, LCCA and LSA were 59.01°, 68.59° and 59.92°, respectively. The mean distance between the BCT and LCCA was 19.59mm and the distance between the LCCA and the LSA was 23.01mm. Significant positive and negative correlations between morphometric data as well as the distribution of morphometric parameters in relation to the anatomical variations have been identified. The illustrated anatomical variations and morphometric data provide cardinal information especially for patients undergoing aortic endovascular intervention, principally for choosing the size, shape and type of the angiographic catheters and devices to be delivered.

Modified Total Arch Debranching TEVAR with Aberrant Left Vertebral Artery.

Total arch debranching and thoracic endovascular repair of an aortic arch aneurysm with a left aberrant vertebral artery are rare procedures. A small artery is difficult to reconstruct and anastomose in a narrow thoracic space with a large aneurysm. We describe an 85-year-old man with a fusiform aortic arch aneurysm and left aberrant vertebral artery who underwent a hybrid procedure with reconstruction of the left aberrant vertebral artery at a surgical site in the neck. Postoperative computed tomography images confirmed exclusion of the aneurysm and patency of all arch vessels, including the left vertebral artery.

A cadaveric study of aortic arch variation in an Irish population.

The aim of this study is to investigate the incidence of variation in the branching pattern of aortic arch (AA) vessels in an Irish population. A cadaveric study of 24 subjects was conducted. The vessels of the AA were identified, their branching patterns were noted and photographed and the following measurements were recorded: the angle of the AA to the coronal plane, the distance from the midline to the brachiocephalic trunk (BCT); the left common carotid artery (LCC) ; the left subclavian artery (LSC), the distance between the BCT and the right subclavian artery (RSC); the RSC and the right vertebral artery (RVA), and between the LSC and left vertebral artery (LVA). The 'normal' branching pattern (BCT, LCC, LSC) was observed in 79%. Thirteen percent had a two-branched AA (bovine variant), while the remainder had an aberrant left vertebral artery (LVA) originating from the AA. The mean distances from the midline to the BCT, LCC and LSC were 9.1, 10.8 and 21.4mm, respectively. Mean distance from BCT to RSC was 34.09mm. The mean distance from LSC to LVA was 39.79mm, and the mean distance from RSC to RVA was 23.38mm. The mean angle of the AA to the coronal plane was 59.02°. This is the first study documenting the rates of variation of the AA in Ireland. Variation of AA branching is of radiological and surgical significance, particularly in the diagnosis and treatment of thoracic and head and neck diseases. Awareness of these variations is particularly relevant for interventionalists who access these vessels during endovascular surgery.

Aortic arch origin of the left vertebral artery: An Anatomical and Radiological Study with Significance for Avoiding Complications with Anterior Approaches to the Cervical Spine.

Complications from anterior approaches to the cervical spine are uncommon with normal anatomy. However, variant anatomy might predispose one to an increased incidence of injury during such procedures. We hypothesized that left vertebral arteries that arise from the aortic arch instead of the subclavian artery might take a more medial path in their ascent making them more susceptible to iatrogenic injury. Fifty human adult cadavers were examined for left vertebral arteries having an aortic arch origin and these were dissected along their entire cervical course. Additionally, two radiological databases of CTA and arteriography procedures were retrospectively examined for cases of aberrant left vertebral artery origin from the aortic arch over a two-year period. Two cadaveric specimens (4%) were found to have a left vertebral artery arising from the aortic arch. The retrospective radiological database analysis identified 13 cases (0.87%) of left vertebral artery origin from the aortic arch. Of all cases, vertebral arteries that arose from the aortic arch were much more likely to not only have a more medial course (especially their preforaminal segment) over the cervical vertebral bodies but also to enter a transverse foramen that was more cranially located than the normal C6 entrance of the vertebral artery. Spine surgeons who approach the anterior cervical spine should be aware that an aortic origin of the left vertebral artery is likely to be closer to the midline and less protected above the C6 vertebral level. Clin. Anat. 30:811-816, 2017. © 2017Wiley Periodicals, Inc.

Supraclavicular transposition of aberrant left vertebral artery for hybrid treatment of aortic arch aneurysm: a case report

BackgroundVertebral artery variations are common in thoracic aortic patients. If patients have the aberrant left vertebral artery, the more difficult to determine the treatment modality.Case presentationWe report the case of a 63-year-old man with an aberrant left vertebral artery originating from an aneurysmal aortic arch. The patient underwent a successful hybrid thoracic endovascular aortic repair after aortic arch debranching and transposition of the aberrant left vertebral artery to the left common carotid artery through a supraclavicular incision without sternotomy.ConclusionsThe aberrant left vertebral artery originating from the aortic arch can be safely transposed to the left common carotid artery through a supraclavicular approach.

Emergent left upper extremity revascularization following stent-grafting of the descending thoracic aorta in a patient with an aberrant left vertebral artery

Aim-Background The indication for performing a left carotid-subclavian bypass in the case of an occluded left subclavian artery following endovascular stent placement in the descending thoracic aorta is not well established.

Hybrid Treatment of a Complex Aortic Arch Aneurysm with an Aberrant Left Vertebral Artery

We report a case of an elderly male with significant comorbidities and a dominant aberrant left vertebral artery originating on an aneurysmal aortic arch. The patient underwent a successful staged hybrid procedure with aortic arch debranching and left vertebral artery transposition onto the left common carotid artery, followed by endovascular aneurysmal repair.

Repair of a Torn Thoracic Aorta, Associated With an Aberrant Left Vertebral Artery

Repair of a Torn Thoracic Aorta, Associated With an Aberrant Left Vertebral Artery

Aberrant left internal mammary artery off an aberrant vertebral artery

We present an image of a 65-year-old female with chest pain and cough who underwent a CT of the chest to rule out a pulmonary embolus. While reviewing the images, incidentally noted was an aberrant left vertebral artery arising directly …