Course Of Artery Research Articles

Superior hypophyseal arteries: angiographic re-discovery, comprehensive assessment, and embryologic implications

The superior hypophyseal arteries (SHAs) are well known in anatomical and surgical literature, with a well-established role in supply of the anterior hypophysis and superjacent optic apparatus. However, due to...

Relation between anterior ethmoidal artery course on computed tomography and supraorbital ethmoid cell and Keros classification.

The anterior ethmoidal artery (AEA) is an important risk area in endoscopic sinus surgery. This study aimed to evaluate the course of AEA according to the Keros classification and the presence of supraorbital ethmoid cell (SOEC) and to prevent possible complications by emphasizing the importance of preoperative paranasal computed tomography (CT) imaging. This approach will increase the effectiveness of endoscopic sinus surgery and improve patient safety. The paranasal CT scan images of patients aged > 18 years between October 2020 and November 2021 from our center were retrospectively analyzed. The images were primarily evaluated in the coronal plane, and the sagittal and axial planes were utilized to evaluate variations in AEA regarding the skull base. Furthermore, the relation of AEA course with Keros classification and SOEC was evaluated. The study included 1000 patients aged 18-80 years (right and left, a total of 2000 samples). Grade 3 AEA was the most common regarding the skull base. Keros Type 2 was the most common classification. Overall, 48.7% patients had SOEC. The incidence of Grade 3 AEA was higher among patients with SOEC and a higher Keros classification compared with those without SOEC and a lower Keros classification. Furthermore, Keros Type 3 was the most associated with SOEC presence. Consistent with the literature, the probability of Grade 3 AEA in patients with high Keros classification and SOEC was significantly higher in our study. Therefore, we consider that preoperative imaging according to Keros classification and SOEC presence can predict AEA course and guide surgery.

Prenatal features of aneurysm of the posterior cerebral artery: a case report

BackgroundFetal cerebral aneurysm other than aneurysm of vein of Galen aneurysmal malformation (VGAM) is extremely rare. This report describes prenatal features of aneurysm of the posterior cerebral artery (APCA) with rapid progression and its natural intrauterine course of the disease, which has never been reported.Case presentationThis is the first report of prenatal features of APCA, detected at 34–36 weeks of gestation, simulating choroid plexus cyst or arachnoid cyst. The diagnosis was based on color flow ultrasound with tracing along the course of cerebral arteries. Also, rendered 3D color flow ultrasound was helpful in demonstrating course of the vessels feeding the aneurysm and supporting the diagnosis. The aneurysm showed nature of rapidly progressive changes, leading to leakage resulting in intracerebral and intraventricular hemorrhage as well as high output state associated with anemia. Prenatal diagnosis and management are very challenging. This case ended up with planned delivery at 37 weeks, giving birth to a surviving male newborn, weighing 2600 g. The neonatal CT brain scans and CTA confirmed the prenatal findings. The prognosis was relatively poor because of extensive intracerebral hemorrhage with severe hydrocephalus and brain midline shift. The couple opted for neonatal palliative care without neurosurgical correction.ConclusionThis study demonstrate that the most important tool for prenatal diagnosis is color Doppler ultrasound, which will demonstrate turbulent blood flow. Three-dimension color Doppler ultrasound is helpful in supporting the diagnosis. The case presented here suggests that the disease has a natural course of rapid progression and massive brain destruction or high output congestive heart failure can be expected.

Application of indocyanine green angiography in repair of facial soft tissue defect using superficial temporal artery based forehead flap

To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap. A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer. Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes. Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.

Efficacy analysis of minimally invasive surgery for Raynaud’s syndrome

BackgroundRaynaud’s syndrome (RS), also referred to as Raynaud’s phenomenon, is a vasospastic disorder causing episodic color changes in extremities upon exposure to cold or stress. These manifestations, either primary Raynaud’s phenomenon (PRP) or associated with connective tissue diseases like systemic sclerosis (SSc) as secondary Raynaud’s phenomenon (SRP), affect the quality of life. Current treatments range from calcium channel blockers to innovative surgical interventions, with evolving efficacy and safety profiles.MethodsIn this retrospective study, patients diagnosed with RS were selected based on complete medical records, ensuring homogeneity between groups. Surgeries involved microscopic excision of sympathetic nerve fibers and stripping of the digital artery’s adventitia. Postoperative care included antibiotics, analgesia, oral nifedipine, and heat therapies. Evaluation metrics such as the VAS pain score and RCS score were collected bi-weekly. Data analysis was conducted using SPSS 26.0, with significance set at p < 0.05.ResultsIn total, 15 patients formed the experimental group, with five presenting fingertip soft tissue necrosis and ten showing RS symptoms. Comparative analysis of demographic data between experimental and control groups, both containing 15 participants, demonstrated no significant age and gender difference. However, the “Mean Duration of RP attack” in the experimental group was notably shorter (9.47 min ± 0.31) than the control group (19.33 min ± 1.79). The RS Severity Score also indicated milder severity for the experimental cohort (score: 8.55) compared to the control (score: 11.23). Postoperative assessments at 2, 4, and 6 weeks revealed improved VAS pain scores, RCS scores, and other measures for the experimental group, showing significant differences (p < 0.05). One distinctive case showcased a variation in the common digital nerve and artery course in an RS patient.ConclusionOur retrospective analysis on RS patients indicates that microsurgical techniques are safe and effective in the short term. As surgical practices lean towards minimally invasive methods, our data supports this shift. However, extensive, prospective studies are essential for conclusive insights.

Three-dimensional vessel wall imaging with 1.5-T MRI to visualize invisible occluded cerebral artery.

Endovascular thrombectomy (EVT) is performed for acute ischemic stroke (AIS) caused by large vessel occlusion; therefore, preoperative visualization of the occluded invisible vessel course reduces complications and ensures success. Three-dimensional (3D) proton density-weighted (PDW) vessel wall imaging (VWI) using variable refocusing flip angle pulse-turbo spin-echo sequences (VRFA-TSE) with 3.0-T magnetic resonance imaging (MRI) can provide this information. To assess the effectiveness of 3D PDW-VWI using 1.5-T MRI without VRFA function. Five consecutive patients with AIS caused by large vessel occlusion underwent EVT in our institute. VWI with 1.5-T MRI using 3D PDW-fast spin echo (FSE) technique was added to conventional brain imaging. PDW-FSE was successfully performed in all cases. 3D PDW-FSE was useful to visualize both the anterior and posterior circulations by clearly revealing invisible vessels but could not demonstrate the length and size of the clot in all five cases. 3D PDW-FSE with 1.5-T MRI without VRFA could clearly depict the course of the invisible occluded artery and might support favorable outcomes after EVT in patients with AIS.

Maxillofacial Radiology Mönckeberg arteriosclerosis

Patient 1: A 75-year-old male presented to the department for the extraction of the 11. Upon panoramic examination (fig. 1), a well defined, curvilinear “railroad track” opacity was noted across the inferior border of the left mandible (white arrow).&#x0D; &#x0D; Patient 2: A 77-year-old male patient was referred for a Cone-Beam Computed Tomography (CBCT) scan (fig. 2) prior to implant therapy. The scan slices demonstrate “pipe-track” and “railroad track” hyperdensities along the course of the facial artery on CBCT examination.

The internal carotid artery in the ontogenesis of selected representatives of the Cervidae family in Poland

In Poland, the environment occurs with the red deer, fallow deer, Eurasian elk and roe deer. Among the ruminants, changes occurring during ontogeny in the arterial system of the head, involving obliteration of the extracranial segment of the internal carotid artery. The aim of this study was to describe the presence and course of the internal carotid artery and indicate the timing of changes in the vascular system of the head associated with the process of obliteration of this vessel. The study was conducted on 146 representatives of the Cervidae family: red deer, fallow deer and roe deer This study showed the presence of a fully preserved internal carotid artery in fetuses and young animals up to the age of about two years. In animals of about 2.5 years of age, only the initial fragment of the internal carotid artery emerging from the carotid sinus and a short fragment directly through the rostral epidural rete mirabile were preserved. In adult animals older than three years the extracranial part of this artery was obliterated.

Transseptal approach in endoscopic sphenoidotomy

INTRODUCTION. Isolated sphenoid sinus disease is a rare condition due to the topographic location of the sinus. In complicated cases and the occurrence of a chronic course, the main method of treatment is surgical cure. There are different approaches to the main sinus, the most effective and safest is endoscopic endonasal sphenotomy. However, in cases of anomalies or disorders of the development of the sphenoid sinuses, as well as the need for combined operations, the transeptal approach may be the method of choice.OBJECTIVE is to evaluate the effectiveness and security of the proposed access.METHODS AND MATERIALS. A prospective analysis was carried out of 52 patients who underwent surgical treatment of isolated sphenoiditis at the Clinic of Otorhinolaryngology of the Pavlov State Medical University in the period from 2018 to 2023.RESULTS. In 5 cases, the sphenoid sinus was opened by transseptal approach. As a result of the analysis of the two approaches, no statistically significant differences were found.CONCLUSIONS. Our surgical interventions with transseptal approach in patients with minor sphenoid sinuses, impaired course of the internal cerebral artery, as well as the need for simultaneous correction of the nasal septum revealed the advisability and effectiveness of approach in such situations, as well as its safety in relation to neurovascular structures.

Analysis of hemodynamic changes in vertebral arteries and veins during functional tests with ultrasound monitoring

Aim to evaluate the correlation between the course of vertebral arteries and veins and the results of calculations of hemodynamic parameters during ultrasound with functional tests.&#x0D; Material and methods. In the observation, 252 volunteers were examined using Samsung SonoAce R7 and GE Logiq F6 equipment. The hemodynamics was studied at the level of the second segment of the vertebral arteries and veins at rest, when turning, tilting and lifting the head. The results were processed using Microsoft Excel 2007 with subsequent statistical analysis.&#x0D; Results. 504 vascular complexes were analyzed without taking into account the visualization side. When assessing the arteries, the highest maximum blood flow velocity was registered when lifting the head in women with a rectilinear course of the vessels. In the group of men with non-rectilinear course of vessels, the lowest average blood flow velocity was registered when tilting the head. The highest volume flow was recorded in case of non-rectilinear vascular course in women when lifting the head.&#x0D; For vertebral veins, the highest indicators of maximum and minimum venous blood flow rates were observed in men with a rectilinear course of vessels when lifting the head. The highest values of the average flow velocity and volume flow were noted in men who had a rectilinear course of the vessels.&#x0D; The maximum values of the calculated venous volume flow were registered in groups with rectilinear vascular course: in men up to 19.4214.85 ml/min. (Me 12.45 ml/min.), in women 18.52 15.30 ml/min. (Me 10.50 ml/min.).&#x0D; Conclusion. The data obtained by the study contributes to improving the software and analysis of individual changes during patient examination, helps to evaluate the effectiveness of treatment and rehabilitation, as well as to analyze multifactorial models.

An aberrant right subclavian artery in a 63-year-old male cadaver.

An aberrant right subclavian artery (ARSA), also called "arteria lusoria", is described as a right subclavian artery (RSA) with a retro-oesophageal course that most frequently originates as the most distal branch of the aortic arch. The aim of the following study was to present and thoroughly describe a case of an ARSA, its course, branches, and relation to the surrounding anatomical structures and discuss the clinical significance and embryology of this variant. During routine dissection, a 63-year-old male cadaver with an abnormal variant of the RSA was found. The RSA branched off from the aortic arch as the most distal branch. Subsequently, it coursed posteriorly to the trachea and oesophagus at the level of T2 and T3. Abnormalities in the branching pattern of the RSA were also discovered, such as the right vertebral artery originating from the right common carotid artery as its first branch. This study presents a case of an ARSA, which is a rare anatomical variant of the branches of the aortic arch. The course and branching pattern of an aberrant subclavian artery is quite variable, and each variant can be associated with different possible complications. Furthermore, the ARSA is associated with other cardiovascular anomalies, such as the Kommerell's diverticulum. Therefore, knowledge about the possible variations of this anomaly may be of great importance for physicians who encounter this variant in their practice.

Surgical Strategy in Patients with Complete Transposition of Internal Organs in Cancer of the Biliopancreatoduodenal Zone

Аim: to present two clinical cases of successful surgical treatment of patients with a combination of complete transposition of internal organs and cancer of the biliopancreatoduodenal zone.Key points. A 65-year-old man underwent gastropancreatoduodenal resection for cancer of the large duodenal papilla. In addition to the situs vicserum inversus, this patient revealed a special variant of vascular anatomy, namely: separate separation of the left and right hepatic arteries from the ventral trunk. A 70-year-old man, in addition to complete transposition of internal organs, had a combination of cancer of the terminal part of the common bile duct and heterotaxy syndrome in the form of polysplenia, aplasia of the hepatic segment of the inferior vena cava, agenesis of the dorsal pancreatic rudiment (“short” pancreas), intrapancreatic course of the right hepatic artery extending from the superior mesenteric arteries, rotational abnormalities of intestinal development. This patient underwent a total pancreatectomy. In both cases, the main difficulties in mobilizing the pancreatoduodenal complex arose due to anatomical disorientation and the absence of standard (familiar) topographic and anatomical landmarks for the surgeon.Conclusion. In all patients with tumors of the biliopancreatoduodenal zone, a detailed assessment of the vascular anatomy of this area is required before surgery, with the study of the course of the main visceral vessels and their large branches using multispiral computed tomography in vascular mode. If heterotaxy syndrome is suspected, additional examination is necessary to identify hidden developmental anomalies, which allows surgeons to be prepared for an unusual situation. Gastropancreatoduodenal resection or total pancreatectomy in situs viscerum inversus is a technically complex intervention and should be performed in large multidisciplinary medical institutions, and the operating team should have extensive experience in operations on the organs of the biliopancreatoduodenal zone.

WTP1.12 Axillary Artery Aneurysm in a Patient of Achondroplasia

Abstract Background Axillary artery aneurysms are extremely rare mainly occurring as pseudo-aneurysms. They are most commonly caused by trauma however; fungal infections, atherosclerosis, connective tissue diseases, vasculitis and thoracic outlet syndrome are also among the etiological factors. Case Summary Seventeen years old, unmarried, achondroplasic (three feet height) girl presented to OPD with pulsatile swelling and pian in right axilla for six months. Pain was accompanied by weakness and numbness of hand. The swelling was initially small in size which increased over time. Patient had history of left axillary artery aneurysm back in 2015 for which left axillary repair was done. There was no history of axillary trauma. On physical examination an approximately 4×2 cm lump was palpable in right axilla. It was round in shape, mobile, pulsatile and non-expanding with no overlying skin changes. The patient had hypotonia with power of 3/5 in all limbs. Deep tendon reflexes were reduced. Rest of systemic examination was unremarkable. CT angiography was done which showed brachiocephalic trunck and right proximal subclavian artery normal. There was a lobulated enhancing area along the course of the Right axillary artery measuring 3.5×4.7×3.0 cm. The axillary artery aneurysm was excised and arterial continuity was restored by placement of Reverse Saphenous vein graft. Discussion The conventional method of axillary artery aneurysm repair is aneurysmectomy followed by placement of bypass graft. Owing to long term patency, saphenous vein graft serves as an ideal for reconstruction. Conclusion axillary artery aneurysms should be considered as a differential for pulsatile axillary swellings and should be promptly treated to avoid life threatening complications.

A familial missense ACTA2 variant p.Arg198Cys leading to Moyamoya-like arteriopathy with straight course of the intracranial arteries, aortic aneurysm and lethal aortic dissection

BackgroundCerebral vasculopathies frequently lead to severe medical conditions such as stroke or intracranial hemorrhage and have a broad range of possible etiologies that require different therapeutic regimens. However, vasculopathies sometimes present with characteristic angiographic findings, that — if recognized — can guide a more specific diagnostic work-up. Certain ACTA2 variants are associated with a distinctive cerebrovascular phenotype characterized by an anomalously straight course of intracranial arteries, dilatation of proximal ICA and stenosis of distal ICA, in the absence of a compensatory basal collateral network found in Moyamoya disease. Until recently, this ACTA2 cerebral arteriopathy has been reported only in ACTA2 variants impairing Arg179.Methods and materialsWe report a familial case of a missense ACTA2 variant p.Arg198Cys with angiographic features of an ACTA2 cerebral arteriopathy. We analyzed the neuroimaging features of all four variant carrying family members and discussed the cerebrovascular abnormalities we found on the background of the current literature on ACTA2 arteriopathies.ResultsNeuroimaging of the variant carriers revealed angiographic abnormalities characteristic for ACTA2 cerebral arteriopathy such as stenoses of the terminal internal carotid artery, occlusion of the proximal middle cerebral artery and an anomalously straight course of the intracranial arteries. In our index patient catheter angiography showed a Moyamoya-like basal collateral network alongside with the above-mentioned features of an ACTA2 cerebral arteriopathy. The detected missense ACTA2 variant p.Arg198Cys was not known to be associated a cerebral arteriopathy, so far. One of the patients later died from aortic dissection — a common vascular complication of ACTA2 variants.ConclusionThe familial case expands the phenotype of the detected ACTA2 variant p.Arg198Cys and hereby broadens the range of ACTA2 variants associated with a cerebral arteriopathy. Further, it emphasizes the importance of an interdisciplinary approach of vasculopathies.

Right coronary artery, a rare and risky course

Right coronary artery, a rare and risky course

Fascinating wonderful network: Rete mirabile of the maxillary artery in cats - minireview.

Cats are one of the most common companion animals, and they differ from dogs in several important ways. Considering the central importance of anatomy in high-quality medicine, the treatment of the feline mandible, mostly during intraoral procedures requiring general anaesthesia, has many important features. In cats, the major artery of the brain is the maxillary artery that forms unique structure - the rete mirabile. The rete mirabile is a plexus like vascular structure that lies extracranially and communicates with brain arterial circle through the orbital fissure. The development of the brain vasculature is different in cats, and it includes obliteration mechanisms of the internal carotid artery. The course of the maxillary artery that forms the rete mirabile has a strong relationship to the angular process of the mandible. Emphasis should be placed on manipulation with the feline mandible, especially during open-mouth procedures, as mistakes can lead to blindness, deafness, and central neurological disorders due to compression of the maxillary artery by the angular process of the mandible. This paper focuses on the anatomy and function of the blood supply to the brain, which is very specific in domestic cats and other felids.

Mapping of Anatomic Variants of the Proximal Vertebral Artery in Relation to Embryology.

Variations in the origins and courses of the vertebral arteries are relatively rare but may be clinically meaningful. We hypothesize a relationship between variant origins of the vertebral arteries and their levels of entry to the foramina transversaria. In this retrospective study of CT angiograms, we document the frequency and types of vertebral artery variants, correlating origins with levels of entry to the foramina transversaria. Vertebral artery variants were observed in 18.7% of a sample of 460 CT angiograms of the neck. Right-sided variants were less common than left (44.2% versus 68.6%, with 12.8% bilateral) and more common than previously thought. The most common variant on both sides was a variant origin proximal to the normal vertebral artery origin and entry at C5. Most right vertebral arteries originating within 2 cm of the origin of the right subclavian artery and left vertebral arteries originating between the left common carotid and subclavian arteries were "high-entry" variants. Most "low-entry" variants, entering at C7, took origin from the arch just distal to the left subclavian artery or at a common origin with the costocervical trunk. Multiple origins or accessory vertebral arteries were also described, and each moiety followed the same rules described for single origins. A map of vertebral artery origins mirrored the map of aortic arch embryology. Vertebral artery variants follow certain well-defined patterns that correlate with the embryology of the aortic arch and great vessels.

Critical Evaluation of Lateral Calcaneal Artery Fascio-Cutaneous Flap in Re-Surfacing Posterior Heel Defects: A Review of 24 Cases.

To assess feasibility and functional acceptability of lateral calcaneal artery fascio-cutaneous flap (LCAFCF) in providing cover to posterior heel defects in single stage. To provide stable and sensate cover to small and moderate posterior heel defects. This review was conducted in department of Burns & Plastic Surgery of Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana between October 2021 and September 2022 to analyse the clinical outcome of LCAFCF in 24 patients (18 males, 6 females) aged between 20 and 35years who had chronic dry wounds n = 9, failed primary reconstruction by reverse sural flap n = 1, granulated wounds n = 8, exposed achilles tendons n = 4 and scarred tissue restricting ankle joint movements n = 2 in region of posterior heel following trauma, while riding motor-cycle. Course of lateral calcaneal artery was marked with hand-held doppler. Flap size ranged from 3 to 3.5cm in width and 5.5-7.5cm length. The donor sites were split skin grafted. Sutures were removed on 22nd day of surgery. Mean follow up was 13months. All flaps survived. Two had partial loss of skin graft and two developed hyperkeratosis on grafted site. Sensations in flap, regain of movements of ankle joint, comfort of walking and driving were acceptable. LCAFCF is handy, safe and reliable flap for re-surfacing difficult wounds of posterior heel, therefore should be included in surgical armamentarium.

Anatomical study of the distal course of the posterior tibial artery: A cadaver study.

This study aimed to describe the course, branches, and variances of the posterior tibial artery, which provides the arterial supply of the plantar surface of the foot, starting from the tarsal tunnel level to provide descriptive information for all surgical interventions, diagnostic radiological procedures, and promising endovascular therapies in the tarsal region. In this study, a dissection of 48 feet was performed on 25 formalin-fixed cadavers (19 males and 6 females). Surgical instruments and a digital caliper were used for dissection and measurements, and the critical structures were recorded by a Canon 250D camera to be illustrated later. All parameters were significantly longer in male cadavers compared to females. According to the correlation analysis, while there was a significant and robust correlation between the axial line and pternion-deep plantar arch (R=.830, P .05), a moderate correlation was found between the axial line and sphyrion-bifurcation (R=.575; P < .05), axial line and deep plantar arch-2nd interdigital commissure (R=.457; P < .05), and sphyrion-bifurcation and pternion-deep plantar arch (R=.480; P < .05). Variation in any branch of the posterior tibial artery was observed in 27 of the 48 studied sides. In our study, the branching and variability of posterior tibial artery on the plantar surface of the foot were described in detail with the determined parameters. In conditions that cause tissue and function loss and require reconstruction, such as diabetes mellitus and atherosclerosis, the most critical factor in increasing treatment success is a better understanding of the region's anatomy.

A clinical case of the retroaortal course of the circumflex artery from the right coronary artery

An anomalous course of coronary arteries is fairly rare pathology, which, however, may underlie clinical manifestations of coronary artery disease. Expanding the possibilities of diagnostic coronary angiography makes it possible to detect numerous types of congenital anomalies of the coronary arteries.However, if earlier they were considered as angiographic findings and were characterized as benign, now this attitude has been changed due to reports of cases of syncope, angina pectoris, and sudden cardiac death associated with their presence. In this regard, a trend emerged to consider such anomalies as “potentially malignant”, which explains special caution at their detection. The article presents a clinical case of an anomalous retroaortic course of the circumflex artery from the right coronary artery.