Frequent Anatomical Variations Research Articles

Reappraisal of the Variations in the Origin of the Obturator Artery With Clinical and Developmental Perspectives: A Cadaveric Analysis.

Background The obturator artery (OA), typically originating from the anterior division of the internal iliac artery (ADIIA), shows significant variability in its origin. Such variations can present clinical challenges during pelvic surgeries, potentially causing unnoticed bleeding and complicating effective treatment. This study aims to thoroughly document the diverse anatomical variations of the OA and explore their implications for surgical practice. Materials and methods Forty-eight hemipelvis specimens from adult human cadavers were dissected. The origin of each OA was meticulously documented, photographed, and analyzed descriptively. Results In 38 specimens (79.2%), the OA originated from the IIA. It branched off at various levels from either the ADIIA or the posterior division of the IIA (PDIIA), either individually or in combination with other named branches. In nine cases (18.8%), the OA originated directly from the external iliac artery (EIA), either as a distinct branch or alongside the inferior epigastric artery (IEA). Additionally, one specimen (2%) exhibited a dual origin involving both the ADIIA and the IEA. Conclusion These findings highlight the frequent anatomical variations in the origin and pathway of the OA. Understanding these variations is crucial for accurately assessing pelvic anatomical relationships, which is essential for effective surgical planning and ensuring procedural safety. This knowledge is particularly important during vascular and surgical procedures, as it can impact the risk of bleeding and the effectiveness of treatment strategies.

The relation of recurrent laryngeal nerve to inferior thyroid artery and extralaryngeal nerve branching may increase the risk of vocal cord paralysis in thyroidectomy

PurposeThe anatomical variations of the recurrent laryngeal nerve (RLN) are common during thyroidectomy. We aimed to evaluate the risk of RLN paralysis in case of its anatomical variations, retrospectively.MethodsThe patients with primary thyroidectomy between January 2016 and December 2019 were enrolled. The effect of age, gender, surgical intervention, neuromonitorisation type, central neck dissection, postoperative diagnosis, neck side, extralaryngeal branching, non-RLN, relation of RLN to inferior thyroid artery (ITA), grade of Zuckerkandl tubercle on vocal cord paralysis (VCP) were investigated.ResultsThis study enrolled 1070 neck sides. The extralaryngeal branching rate was 35.5%. 45.9% of RLNs were anterior and 44.5% were posterior to the ITA, and 9.6% were crossing between the branches of the ITA. The rate of total VCP was 4.8% (transient:4.5%, permanent: 0.3%). The rates of total and transient VCP were significantly higher in extralaryngeal branching nerves compared to nonbranching nerves (6.8% vs. 3.6%, p = 0.018; 6.8% vs. 3.2%, p = 0.006, respectively). Total VCP rates were 7.2%, 2.5%, and 2.9% in case of the RLN crossing anterior, posterior and between the branches of ITA, respectively (p = 0.003). The difference was also significant regarding the transient VCP rates (p = 0.004). Anterior crossing pattern increased the total and transient VCP rates 2.8 and 2.9 times, respectively.ConclusionRLN crossing ITA anteriorly and RLN branching are frequent anatomical variations increasing the risk of VCP in thyroidectomy that cannot be predicted preoperatively. This study is the first one reporting that the relationship between RLN and ITA increased the risk of VCP.

Reliability of Neuronavigation in Localizing the Internal Acoustic Canal during Middle Fossa Approach

Abstract Objective The absence of precise landmarks in the middle fossa floor and frequent anatomical variations make it difficult to localize the internal acoustic canal (IAC) during the middle fossa approach (MFA). We aimed to investigate the reliability and utility of the neuronavigation system (NNS) in the MFA and to delineate specific technical considerations regarding NNS during the approach. Method One-millimeter-thin section computed tomography scans were performed on five formalin-fixed human cadavers (10 sides). During the MFA, structures, such as the IAC, vestibule and cochlea hidden in the temporal bone were investigated under NNS guidance. Results All the superficial landmarks, such as the foramen spinosum and ovale were correctly localized by NNS. Deeper landmarks, such as the central part of the IAC lying beneath the surface of the petrous apex could not be localized via NNS. The exact area of bone removal along roof of IAC was determined by using the orientation provided by the probe placed between the basal turn of cochlea and the vestibule. We were able to validate the location of the IAC via a medial to lateral drilling by using the navigation this reference point. Conclusion The NNS can be used effectively during the MFA, and localizing superficial landmarks on the middle fossa floor with a higher accuracy may prove helpful in identifying the IAC from above. By referring to the cochlea–vestibule junctional area, the exact location of the trace of the IAC can be revealed.

An assessment of Martin-Gruber anastomosis discrepancies between healthy individuals and patients with carpal tunnel syndrome in motor nerve conduction studies.

Background: The Martin-Gruber anastomosis (MGA) represents a nerve innervation anomaly in the upper extremity, potentially leading to misinterpretation during standard nerve conduction studies (NCSs). This study aims to characterize the electrophysiological attributes of MGA in both healthy subjects and individuals diagnosed with carpal tunnel syndrome (CTS). Methods: This case-control study involved the electrophysiological assessment of 506 forearms, segregated into two distinct groups: a CTS positive (+) case group and a CTS negative (-) control group. The evaluations were conducted over an average period of 8 months in the neurophysiology laboratory. The study encompassed 294 forearms from 147 healthy individuals without CTS and 212 forearms from 106 patients diagnosed with CTS, both clinically and electrodiagnostically. Results: The relationship between the presence of type I MGA and the CTS (+) group was statistically significant (P = 0.002). Similarly, the relationship between the presence of type II MGA and the CTS (+) group was statistically significant (P = 0.013). On the other hand, the relationship between the presence of type III MGA and the CTS (+) group was not statistically significant (P = 0.208). Likewise, the relationship between the presence of type IV MGA and the CTS (+) group was not statistically significant (P = 0.807). The correlation between the side of type I MGA and the groups did not reach statistical significance (P = 0.770). The relationship between the side of type II MGA and the groups also did not attain statistical significance (P = 0.990). Similarly, the side of type III MGA and its association with the groups did not yield statistical significance (P = 0.402). Finally, the relationship between the side of type IV MGA and the groups was not statistically significant (P = 0.166). Conclusion: The MGA represents a relatively frequent anatomical variation observed in the upper extremity. Notably, its presence demonstrated significance in the first dorsal interosseous (FDI) muscle (type II) and the abductor digiti minimi (ADM) muscle (type I) among patients with CTS. The present study emphasizes the importance of recognizing this variation during upper extremity NCSs for a correct diagnostic approach and treatment plan to avoid misdiagnosis of median-ulnar peripheral neuropathy.

SINONASAL ANATOMICAL VARIATIONS IN PATIENTS WITH CHRONIC RHINOSINUSITIS

Objective: The nose and paranasal sinuses have a wide range of structural changes that are best diagnosed with computed tomography (CT). Anatomical variations are minor anatomical defects that occur around the osteomeatal complex that can block paranasal sinus drainage and ventilation. The purpose of this study was to determine the prevalence of structural abnormalities of the nose and paranasal sinuses in chronic rhinosinusitis (CRS) patients. Methods: This cross-sectional study included 100 patients with CRS who visited the ENT outpatient department and had been suffering from the condition for more than 3 months without responding to medical treatment. CT PNS scans were used to determine the prevalence of anatomical abnormalities in these patients. Results: The majority of the patients were between the ages of 31 and 40 years. The most common presenting symptom was nasal obstruction (86%), followed by headache (60%). The most prevalent anatomical abnormality encountered in our study was a deviated nasal septum (70%) and concha bullosa occurring in 35% of cases. Conclusion: In our study, the most frequent anatomical variation was a deviated nasal septum. Patients with prolonged symptoms who are not improving with appropriate medical care are advised to get a CT scan to find any structural changes.

A rare find of a maxillary third molar with five roots: a case report of an unusual morphology.

Third molars are frequently absent or impacted; their unpredictable prevalence and morphology, with frequent anatomical variations, is a challenge for the practitioner. The number of roots of the upper third molars vary from one to five, but five roots upper third molars' cases are extremely rare. The case reported here is of a normotrophic male patient, with no significant general medical history, having extracted an impacted maxillary upper molar, with an unusual position and dimensions and five completely separated formed roots, orientated in diverse directions. It highlights the importance of using the correct surgical technique, without excessive pressure, for avoiding the fracture of the maxillary tuberosity, the displacement of the molar into the pterygopalatine fossa or the opening of the maxillary sinus, especially in the absence of good quality imagistic information like cone-beam computed tomography. The case presented in this paper is very rare and highlights the significance of anatomical knowledge, which is mandatory for managing these cases, to avoid trauma, accidents, and complications and to maintain an optimal time of extraction, since such variations occur, and the conventional radiographs do not offer enough data to clarify the diagnosis.

Roles of Anatomical Abnormalities in Localized and Diffuse Chronic Rhinosinusitis

BackgroundThis study aimed to examine the roles of anatomical variation in localized and diffuse chronic rhinosinusitis [LCRS and DCRS]) .MethodsA database was analyzed retrospectively on patients hospitalized in the Department of Otorhinolaryngology of our university hospital from 2017 to 2020. A total of 281 patients were included and divided into three categories: patients with LCRS, patients with DCRS, and a normal control group. The frequency of anatomical variation, the demographic information, disease type (with or without polyps), symptom visual analogue scale (VAS) scores and Lund-Mackay (L-M) scores were calculated and compared.ResultsAnatomical variants were observed more frequently in LCRS than DCRS (P < 0.05). The frequency of variation was higher in the LCRSwNP group than the DCRSwNP group (P < 0.05), and higher in the LCRSsNP group than the DCRSsNP group (P < 0.05). The L-M scores for patients with DCRS with nasal polyps were significantly higher (14.96 ± 6.15) than those of patients with DCRS without nasal polyps (6.80 ± 5.00) and also significantly higher (3.78 ± 2.07) than those of patients with LCRS with nasal polyps (2.63 ± 1.12; P < 0.05). A poor correlation was observed between the severity of symptoms and the performance of CT scans in CRS (R = 0.29, P < 0.01).ConclusionAnatomical variants were common in CRS, and possibly correlated with LCRS but not with DCRS. The frequency of anatomical variation is not associated with the occurrence of polyps. CT could reflect the severity of disease symptoms to some extent.

Ultrasound-Guided Treatment of Meralgia Paresthetica: With or Without Corticosteroid? A Double-Blinded, Randomized Controlled Study.

Blockade of the lateral femoral cutaneous nerve (LFCN) with local anesthetic (LA) has therapeutic role as well as diagnostic value for meralgia paresthetica (MP). The aim of this study was to compare the effectiveness of ultrasound-guided LA and LA + CS injections in the treatment of MP. This was a prospective, double-blinded, randomized controlled study. Thirty-two patients were evaluated clinically, and electrophysiologically and diagnosed as MP by diagnostic block. They were randomly assigned to two groups and all patients completed the study. The first group (n = 17) received 2 mL of lidocaine 2%+1 mL of betamethasone, while the second group (n = 15) received 2 mL of lidocaine 2% + 1 mL saline solution. No statistically significant difference was detected between the groups in numeric rating scale (NRS) values. In both groups, NRS values were significantly decreased after the injection that confirms the diagnosis of MP. The improvement continued on the following weeks in both groups. At the 4th week, the NRS value reached to 2.47 in the CS group and reached to 3.13 in the LA group. Both CS and LA injections for the treatment of MP were found to be clinically effective and both may be therapeutic options. In intractable cases, once the nerve block is applied with or without CS, well-being can be achieved by keeping the patient away from the triggering factors. To provide effective and isolated injection of LFCN, that may have frequent anatomical variations, ultrasonography guidance could be suggested.

Prevalence of accessory renal artery and other renal artery variants in south Indian population by CT-Angiography

The most frequent anatomical variations of the renal arterial system are accessory renal arteries (supernumerary renal arteries) and aberrant renal arteries, which occur in varying numbers among various ethnic and racial groups. Prior to surgery, understanding these variations is crucial because it affects the decision to use donor kidneys, the planning of partial nephrectomy, and other urological procedures. Along with the main renal artery on the same side, there is also an accessory renal artery. The aberrant artery supplies the kidney without passing through the hilum, whereas the main renal artery enters the kidney through the hilum to do so.Aim: This tertiary care hospital-based study aims to know the prevalence of variations of the renal arterial system including accessory renal artery, their distribution pattern, and association with gender, age, and side predilection in population of Kancheepuram and West Chennai district of Tamil Nadu.Methodology: One hundred adults (62 males, 38 females; mean age: 45 +/- 25 years) inclusive of prospective live renal donors undergoing pre-operative CT renal angiogram for operative planning and other patients undergoing CECT Abdomen for various abdomino-pelvic pathologies were selected for the study.Research Design: It is a cross-sectional descriptive study conducted in the Department of Radiology, of a tertiary care hospital in Kancheepuram district of Tamil Nadu, India.Results: Renal artery variants (including Accessory renal and aberrant renal arteries) are present in 23% of kidneys. The prevalence of renal artery variants in males – is 30%, and in females – 11%. On the right side the prevalence is 60% and on the left side is 26%. The prevalence of bilateral renal artery variants is 11%.

The relationship between anatomical variations and paranasal sinus volumes with climate and altitude

The aim of this study was to evaluate the effect of climate and altitude differences on the volume of paranasal sinuses and on the frequency of anatomic variations by comparing the paranasal sinus computerized tomography (PNSCT) of patients who were born and living in a cold, dry climate at high altitude with those of patients who were born and living on the coast at sea level in a temperate climate. We also aimed to determine differences relating to gender. Axial and coronal CT sections were used for volume measurements in the paranasal sinuses. For measurements, the widest view of the sinuses was used. The findings of this study have shown that age groups and genders compared measurements between the two cities. When the age groups are examined, there is no significant difference between the regions between 0-20 years of age (p&gt; 0.05), whereas 21-40,41-60,61 and above individuals have a significant difference between the frontal and sphenoid sinuses (p 0.05). Besides, when the diameter of the paranasal sinuses between regions is examined; It was found that individuals in Adana were longer than Sivas (p

Anatomical variation of the branching of the Celiac Trunk: case report

Introduction: The celiac trunk originates from the descending abdominal aorta and, after a short course of one to three centimeters, divides into the left gastric, common hepatic and splenic arteries. Methods: We performed the dissection of the abdomen of an adult male cadaver from the Department of Anatomy, Faculdade de Ciências Médicas de Minas Gerais (CMMG). Result: An unusual pattern of branching of the arteries of the celiac trunk was identified, which appears to give rise to four branches: the left gastric, splenic, common hepatic and gastroduodenal arteries. Discussion: Due to the high miscegenation in Brazil, the frequency of anatomical variations may be different from other literature, being important studies on cadavers in this country. Knowing the anatomical variations present in the branches of the celiac trunk contributes to reducing morbidity and mortality in procedures in region, being the performance of angiotomography or angioresonance, for prior knowledge of the anatomical variations, extremely important in major surgeries. Conclusion: Anatomical variations in the celiac trunk are common and their knowledge is essential to avoid complications in abdominal surgical procedures.

Outcomes in the treatment of aberrant subclavian arteries using the hybrid approach.

and keywords OBJECTIVESAberrant subclavian artery (ASCA) occurs rarely but is one of the most frequent anatomical variations of the supra-aortic trunks. No consensus has been established on its best treatment. The goal of this study was to report the outcomes of ASCA treated by the hybrid approach.METHODSThis non-interventional retrospective multicentre analysis included patients treated for ASCA by the hybrid approach in 12 French university hospitals between 2007 and 2019. The hybrid approach was defined as an endovascular procedure combined with open surgery or a hybrid stent graft. Patients were divided in 4 groups (from less to more complex treatment). The primary end point was 30-day mortality. The secondary end points were 30-day complications and late mortality.RESULTSThis study included 43 patients. The mean age was 65 (SD, standard deviation: 16) years. Symptoms were found in 33 patients. Subclavian revascularization combined with aberrant subclavian artery occlusion was undertaken in 13 patients. Unilateral and bilateral subclavian revascularization combined with a thoracic aortic stent graft was undertaken in 11 and 6 patients, respectively. Total aortic arch repair combined with a thoracic aortic stent graft was undertaken in 13 patients. Thirty-day mortality was 2.3% with a technical success rate of 95.3%. The 30-day major postoperative complication rate was 16.3%: 4 strokes, 2 tamponades, 1 acute respiratory distress syndrome. Mean follow-up was 56.3 (SD: 44.7) months. The late mortality was 18.6%.CONCLUSIONSThe ASCA hybrid approach is feasible, safe and effective with low early mortality. Morbidity is rather high. However, it increases with the complexity of the hybrid approach, which should be kept as simple as possible if the anatomical morphology allows.

Novel anatomical findings with implications on the etiology of the piriformis syndrome

PurposeThe cause of the piriformis-related pelvic and extra-pelvic pain syndromes is still not well understood. Usually, the piriformis syndrome is seen as extra-pelvic sciatica caused by the entrapment of the sciatic nerve by the piriformis in its crossing through the greater sciatic foramen. However, the piriformis muscle may compress additional nerve structures in other regions and cause idiotypic pelvic pain, pelvic visceral pain, pudendal neuralgia, and pelvic organ dysfunction. There is still a lack of detailed description of the muscle origin, topography, and its possible relationships with the anterior branches of the sacral spinal nerves and with the sacral plexus. In this research, we aimed to characterize the topographic relationship of the piriformis with its surrounding anatomical structures, especially the anterior branches of the sacral spinal nerves and the sacral plexus in the pelvic cavity, as well as to estimate the possible role of anatomical piriformis variants in pelvic pain and extra-pelvic sciatica.MethodsHuman cadaveric material was used accordingly to the Swiss Academy of Medical Science Guidelines adapted in 2021 and the Federal Act on Research involving Human Beings (Human Research ACT, HRA, status as 26, May 2021). All body donors gave written consent for using their bodies for teaching and research. 14 males and 26 females were included in this study. The age range varied from 64 to 97 years (mean 84 ± 10.7 years, median 88).Resultsthree variants of the sacral origin of the piriformis were found when referring to the relationship between the muscle and the anterior sacral foramen. Firstly, the medial muscle origin pattern and its complete covering of the anterior sacral foramen by the piriformis muscle is the most frequent anatomical variation (43% in males, 70% in females), probably with the most relevant clinical impact. This pattern may result in the compression of the anterior branches of the sacral spinal nerves when crossing the muscle.ConclusionsThese new anatomical findings may provide a better understanding of the complex piriformis and pelvic pain syndromes due to compression of the sacral spinal nerves with their somatic or autonomous (parasympathetic) qualities when crossing the piriformis.

Coronary unroofing does not fits all anomalous aortic origin of coronary arteries.

Anomalous aortic origin of coronary artery (AAOCA) is the second leading cause of sudden cardiac death in children and young adults. Intramural-interarterial course is the most frequent anatomic variation and coronary unroofing is widest adopted for surgical management. Symptoms recurrence is described regardless of the technique used. This study aims to describe how an anatomic patient-centered approach aimed to restore a normal coronary artery take-off is associated with symptoms resolution. From 2008 to 2021, 25 patients were operated on for an AAOCA at a median age of 20 years. Nineteen patients had a right AAOCA and six had left AAOCA. Intramural course was present in 18 patients. Seventy-six percent were symptomatic. No episodes of aborted sudden cardiac death before surgery was described in the population. Surgical technique used were coronary unroofing in 18 patients, coronary neo-ostioplasty in 3, coronary Reimplantation in 3, and main pulmonary artery re-location in 1. No hospital mortality or reoperation was observed in our experience as well as major complications related to surgery. Mean hospital length of stay was 8.5 days. None of patients reported symptoms recurrence at follow-up. Young athletes returned to play competitive sport. Postoperative computed tomography scan evaluation showed a general improvement of the take-off angle. AAOCA requires a patient anatomic-based surgical management. There is not a single surgical technique that can fits all anatomic subtype of AAOCA. Surgical techniques may be selected on the base of the preoperative images and intraoperative findings. In our experience, this policy is associated with no symptoms recurrence.

Calcification of the Atlanto-Occipital Ligament (Ponticulus Posticus) in Orthodontic Patients: A Retrospective Study.

Background: Ponticlus Posticus (PP) is a rare anomaly of the first cervical vertebra easily identifiable in lateral cephalometric radiograph and typically required for orthodontic diagnosis. The aim of this study is to evaluate the PP prevalence in lateral Cephalograms in a cohort of orthodontic patients treated at the Dental School of the University of Bari ‘Aldo Moro’, Italy, and to find possible connection between PP and other dental anomalies, as well as the patient’s cephalometric characteristics. Methods: A total of 150 panoramic radiographs and 150 lateral Cephalograms, obtained for orthodontic use only, were evaluated. No patients were referred to for congenital syndromes or disease, or a history of previously occurred maxillofacial trauma. A detailed cephalometric study was performed for each patient, and the whole cohort was divided according to the common three dental malocclusion classes. The values obtained were analyzed using the Chi-Square Test. Results: PP prevalence was 8% (12 of 150 cases), where the complete and partial forms observed 4.7% and 3.3%, respectively. Although females were more affected (9.6%), no statistically significant sex-related difference was found. Furthermore, no statistically significant relationship regarding age or dental anomalies (dental agenesis/palatal impacted canines) among the groups was observed either. Cephalometric analyses revealed that half of the subjects with PP were sagittal skeletal class I and had vertical hyper-divergence. Conclusions: PP is a frequent anatomical variation of the cervical vertebra, apparently unrelated to the skeletal malocclusion type or dental anomalies. The current study needs to further confirm the congenital hypothesis of PP’s origin already reported in literature.

Safety and Intraoperative Results in Live Kidney Donors with Vascular Multiplicity After Hand-Assisted Laparoscopy Living Donor Nephrectomy.

Background and PurposeVascular multiplicity is the most frequent anatomic variation in kidney donors. Despite concerns about risks, these allografts are increasingly used to overcome the shortage of kidney donors. The safety and clinical outcomes in living kidney donors were evaluated with vascular multiplicity after hand-assisted laparoscopic living donor nephrectomy (HALDN).Patients and MethodsData from all living kidney donors who underwent HALDN from 2008 to 2021 was retrospectively reviewed. Patients were divided into two groups as single (SRV) and multiple renal vessels (MRV), and a comparative analysis was done. The primary outcomes include operating room time (ORT), days of hospital stay, estimated blood loss, complications, conversion, and re-operations.ResultsMRV were present in 166 out of 612 donors (27.1%). Among those, 10 (1.6%) donors had simultaneous multiple arteries and veins. Additionally, the prevalence of artery and vein multiplicity was 21.8% (n = 134) and 3.5% (n = 22), respectively. Warm ischemia time was significantly different among the two groups but not clinically important. The number of conversions to open technique, the mean ORT, the median blood loss, and days of hospital stay were similar between the SRV and MRV groups, without significant differences. According to the modified Clavien-classification system, no differences were found in the complication rates between the two groups (p = 0.29). Complication rates were 3.3% and 3.6% for the SRV and MRV groups, respectively.ConclusionHALDN is a procedure with safe intraoperative results, even with vascular multiplicity. The presence of multiple renal arteries or veins has no negative impact on the outcome of the donor after living donor nephrectomy.

Prevalence and morphometric analysis of the retromolar canal in a Spanish population sample: a helical CT scan study.

Background The retromolar canal (RMC) is an anatomical variation of the mandibular canal (MC) whose identification and study should be considered given its implication in the surgical procedures of the retromolar area. The prevalence of the RMC widely varies according to previous studies and may be influenced by the followed study method. This work aimed to evaluate the prevalence of the RMC in a Spanish population sample.Material and Methods For this purpose, 225 CT scan images (with a higher resolution than the cone beam CT used in other previous studies) from the Hospital Clínico Universitario de Valencia were analyzed. The Osirix MD® radiological image analysis system was applied to analyse the dimensions, location in the retromolar area and morphologic characteristics of the RMC by classifying them according to their typology. Furthermore, the relations between the RMC and gender, age and laterality were studied.Results RMC prevalence was 23.1%. No significant relation between the presence of the canal and gender, age or laterality was found. Type Ia was the commonest type with a prevalence of 40.8%.Conclusions Based on the results of this study, the RMC should be considered a frequent anatomical variation whose complete study is very important in daily clinical practice. Key words:Retromolar canal, retromolar foramen, retromolar triangle, mandibular canal, mandibular nerve, inferior alveolar nerve, CT scan, Helical scan.

Is balloon cryoablation effective in common pulmonary trunk?

Abstract Introduction Common pulmonary trunk (CPT) accounts for the most frequent pulmonary vein anatomical variation. The most frequent technique used for pulmonary vein isolation (PVI) is point-by-point radiofrequency, using cryoablation (CB) is still debatable. Some few studies have shown the feasibility and safety of CB in CPT atrial fibrillation (AF) patients (pts), most of them performed angio-CT prior to ablation. Purpose To analyzed AF pts with and without CPT submitted to CB in regarding of success rate and safety. Methods Single-center retrospective study of consecutive AF pts refractory to antiarrhythmics submitted to CB between 2017 and 2020. Before the procedure auriculography was performed in all pts to verify variations in pulmonary veins, however the procedure was not modify regarding the presence of CPT. Clinical records were analyzed to determine baseline characteristics, success rate and complications. Monitoring was performed with a 7-day event loop recorder at 3, 6 and 12 months and annually from the 2nd year. Success was defined by recurrence of AF (duration &amp;gt;30 seconds). Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using Chi-square and Mann-Whitney analysis. Results A total of 232 pts (60±12 years, 68% males) underwent CB. 29 pts had CPT (28 – common left pulmonary trunk and 2 – common right pulmonary trunk). Baseline characteristics were similar between groups, except for CHA2DS2VASc score and prior cerebrovascular disease history which were higher in CPT pts (3±2 vs 2±2, p=0.001; 24.1% vs 6.8%, p=0.007, respectively). The mean baseline CHA2DS2VASc was 2±2 and the median post-CB follow-up was 135 (IQ 32–249) days. Both the 1 and 3 year arrhythmic recurrence after AF ablation was not significantly different when comparing CPT and non CPT group with a 3 year success rate of 95.8% in pts with CPV against 86.5% in pts without CPT (p=0.299). There was no difference between groups (p=0.296; p=0,164, respectively) regarding the time of the procedure, radiation dose and rate of complications. Conclusions In our experience, balloon cryoablation for PVI is a safe and successful procedure in patients with CPT anatomical variation. Funding Acknowledgement Type of funding sources: None.

Vertebral artery hypoplasia as an independent risk factor of posterior circulation atherosclerosis and ischemic stroke.

Vertebral artery hypoplasia (VAH) is a frequent anatomical variation of vertebral arteries, with emerging evidence suggesting that it contributes to posterior circulation ischemia. However, the relationship between VAH and ischemic stroke remains unknown. Hence, this study aimed to determine the prevalence of VAH in patients diagnosed with acute ischemic stroke who were followed up in a neurology clinic and to determine if it can potentially be a risk factor for atherosclerotic stenosis in vertebrobasilar circulation.This retrospective study included 609 patients diagnosed with acute ischemic stroke between January 1, 2019 and January 1, 2020. Demographic of patients, risk factors, radiological and clinical characteristics were evaluated.Posterior circulation was very common in patients with VAH, and the most common locations of atherosclerotic stenosis were V1 and V4 segments of the vertebral artery and the middle segment of basilar artery. Analysis of the risk factors for atherosclerotic stenosis in patients with posterior circulation acute ischemic stroke suggested that VAH was an independent risk factor.Findings of the study suggest that VAH pre-disposes atherosclerotic stenosis in vertebrobasilar circulation, although its mechanism remains unknown. Hemodynamic parameters associated with atherosclerosis could not be measured in vivo. Thus, to better understand the underlying mechanism, conducting studies that examine blood flow parameters with high-resolution magnetic resonance angiography in patients diagnosed with acute cerebral ischemia patients with VAH is warranted.

A cadaveric analysis of anatomical variations of the anterior belly of the digastric muscle.

The anterior belly of the digastric muscle (ABDM) presents highly variable and frequent anatomical variations. Since the ABDM functions as a landmark for clinical procedures involving the submental region, it is important to have a comprehensive understanding of its variations. In this study, we sought to improve our knowledge of ABDM variations in the ethnically diverse whole-body donor population in Northern California. Specific aims were: (1) to determine the frequency of ABDM and anterior belly (AB) accessory muscle variations in cadavers donated to the UC Davis Body Donation Programme, (2) to classify these variations identified in this population using the previously proposed nomenclatures by Yamada (1935) and Zlabek (1933), and (3) to investigate the innervation and arterial supply to the representative ABDM and AB accessory muscle variations. During the 2018 and 2019 gross anatomy dissection laboratories at the UC Davis School of Medicine, the submental regions of 48 cadavers were examined and classified. Fifteen (31.2%) cadavers presented ABDM and AB accessory muscle variations. These variations were clearly categorised using the morphology of the ABDMs and attachments of the AB accessory muscles. We also identified three previously unreported types of variations, two of which presented the fusion of right and left ABDMs and one presenting an ectopic tubercle beneath the mandibular symphysis to which a pair of AB accessory muscles were attached. Anterior belly of the digastric muscle variations were found in 1 in 3 individuals in the local Northern California population. Knowledge of the prevalence and common patterns of ABDM variations in the general population would be valuable information when an operation or examination is performed in the submental region.