Origin Of Left Vertebral Artery Research Articles

Unique segmental branching of right pulmonary artery in association with patent ductus arteriosus and anomalous carotid origin of left vertebral artery.

Unique segmental branching of right pulmonary artery in association with patent ductus arteriosus and anomalous carotid origin of left vertebral artery.

Dual origin of left vertebral artery.

We present a case of a 60-year-old female with headache and vertigo where computed tomography (CT) angiography incidentally revealed a dual origin of the left vertebral artery in which the dominant lateral limb of the left vertebral artery was arising from the left subclavian artery while the accessory medial limb was seen arising from the aortic arch with fusion of the two limbs seen cranial to the transverse process of the sixth cervical vertebra.

Anatomical variation in the branching pattern of the aortic arch: a literature review.

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. Embase and Medline database searches were carried out in June 2021 and identified 1197 articles, of which 24 were considered eligible. 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. 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.

Arch and Great Vessel Geometry From a Transradial Angiographic Approach

Background Neuroendovascular practices are transitioning from transfemoral to a radial‐first approach for cerebral angiography. Developing radial‐specific devices requires a comprehensive understanding of vessel size and geometry encountered from a right radial approach. We developed a database of aortic arch and vessel measurements relevant for radial‐specific device development. Methods The database contained 100 consecutive neck computed tomographic angiograms conducted on a 256‐slice emergency department computed tomographic scanner. Arch characteristics and measurements obtained from 1‐cm maximum intensity projection reformats included arch type and diameter, bifurcation angles, and distances from the arch to vessel origins. Statistical analysis was conducted using Excel and R. Results The database contained 56 female and 44 male patients; the average age was 62 years. A total of 46% had type 2 or 3 arch configuration, 19% had bovine configuration, and 5% had a left vertebral artery originating directly from the arch. Median angles at the arch from the innominate ranged from 20° to 47° and at branch vessels from 16° to 63° with large variation. The left carotid bifurcation was ≈8 cm further than the right carotid bifurcation. The left vertebral artery origin was median 3.8 cm from the arch. Conclusions We cataloged aortic arch and vessel geometries that have implications for catheter and device performance from a transradial approach. For example, a standard guide catheter that is adequate length for the right anterior circulation must be at least 8 cm longer for comparable distal support on the left because of the difference in distance from the right to the left. Catheter tip shape may be further optimized to improve vessel selection. Currently used catheters make a reverse curve angle of ≈15°, although most great vessels are at between 15° and 45°. Finally, the length of the distal arm of reverse curve catheters is just >4 cm, frequently inadequate to easily reach the left vertebral artery origin (median distance, 3.8 cm in this study). Transradial devices should be developed with these constraints in mind. This database provides benchmarks for future catheter design.

Anomalous Origin of the Left Vertebral Artery from the Aortic Arch: A Case Report

This study presents and describes the anatomical variation of the left vertebral artery arising from the aortic arch in two female cadavers, discovered during dissection in an anatomical laboratory setting. This anomaly was initially discovered during a routine cadaveric dissection of the neck of a 64‐year‐old female cadaver. This finding prompted an evaluation of the remaining twenty‐five cadavers in the lab, leading to the discovery of the same variation in an 83‐year ‐old female. In both cadavers, the left vertebral artery originated from the aortic arch in between the origins of the left common carotid artery and the left subclavian artery. This is a variation, as the vertebral artery is typically known to branch off of the first part of the subclavian artery on both the right and left side. Following this discovery of the anomaly in the laboratory, a literature review was conducted to understand the prevalence of this variation in the general population as well as its clinical implications.

Simultaneous Association of Variations in the Origin and Diameter of the Left Vertebral Artery in a Patient with a C1 Lateral Mass Tumor

The anomalous origin of a hypoplastic Left Vertebral Artery (LVA) from the aortic arch is a rare anatomic variant. This study discusses the case of a patient with a C1 lateral mass tumor that surrounded a dominant Right Vertebral Artery (RVA) according to preoperative computed tomography angiography, with a hypoplastic LVA originating from the aortic arch. Surgery was performed, and the patient recovered uneventfully. To date, no study has reported the simultaneous association of two variations (origin and diameter) in the LVA. A deep understanding of abnormalities in the diameter and origin of LVA is a must for neurosurgeons as well as for thoracic and vascular surgeons to conduct surgical procedures.

Dual Origin of Left Vertebral Artery- A Case Report of an Uncommon Vascular Variant

Vertebral artery duplication is relatively an uncommon vascular variant. It is a developmental anomaly with a dual origin and has different levels of fusion in the neck. It is usually an incidental finding found during workup of other clinical conditions. Due to its anatomical similarity with arterial dissection it is often misinterpreted on vascular imaging so a thorough understanding of this vascular variant is necessary to avoid diagnostic and therapeutic complications during endovascular interventions. A 43-year-old male presented with complaints of pain and discolouration of fingers of left hand since 2 days. Computed Tomography (CT) angiography of upper limb was done which revealed short segment near complete to complete occlusion/thrombosis of proximal left subclavian artery which was seen 8 mm from its origin with distal reformation by the collaterals. There was an evidence of hypoplastic V1 segment of native left vertebral artery, a small artery was seen arising from the aortic arch in the middle of common carotid and left subclavian artery origins, which was found to be duplicated vertebral artery with dual origin from both the subclavian artery and aorta with fusion of both the limbs at C4-C5 levels.

Incidental identification of the aberrant origin of left vertebral artery using magnetic resonance angiography: A case report

Background: The vertebral arteries originate from the root of the neck as the first branches of the subclavian arteries. Variations of vertebral arteries are congenital anomalies occurring during embryonic development. Anatomic variations of the left vertebral artery are clinically symptomless and recognized incidentally during angiographic assessments or imaging techniques so the diagnosis of these anomalies is a serious challenge. Anomalous origin of vertebral arteries may lead to neurologic disorders. It is, thus, important to identify variations of the large vessels of the aortic arch when planning neck and cervical spine interventions and diagnostic radiology. For this reason, we would like to present this rare case of left vertebral artery showing a different origin. Case report: In this work, we describe a 60-year-old female patient with headache, lethargy and blurred vision. We employed magnetic resonance angiography for both the brain and neck. There was no lesion in the brain. Incidentally, we found that the root of the left vertebral artery was anatomically aberrant. The left vertebral artery arose from the nearest section of the left external carotid artery, next to the bifurcation of the left common carotid artery, which is a rare variation. Conclusion: Understanding the state of anomalous variations of the origin of the vertebral artery might have crucial implications in angiographic and surgical procedures. It is beneficial to perform more screening with noninvasive studies like neck magnetic resonance angiography in clinical cases with potential symptoms coexisting with other diseases in order to predict possible future problems in intracranial and extracranial interventions. Keywords: Vertebral artery; external carotid artery; anatomic variation; magnetic resonance angiography.

Anatomical Variations of the Aortic Arch: A Computerized Tomography-Based Study.

IntroductionDespite adequate preparation and meticulous pre-operative assessment, variations of the vascular anatomy of the aortic arch may lead to clinical dilemmas. In the present era, with the easy availability of imaging facilities, various anatomical variations can be found out prior to an interventional procedure. However, there are many countries including India where such facilities may still be not widely available. The purpose of this study was to assess the prevalence of these anatomical variants in patients undergoing Computerised Tomography (CT) chest with contrast.MethodsThis observational study involved patients who underwent CT chest with contrast as part of various clinical indications during a three-year period in a tertiary care centre in South India. Variations of the aortic arch and its branching pattern were studied in 4,000 chest CT images of patients referred to the radiology department. ResultsA total of 4,000 patients underwent CT chest with contrast during the study period. Twenty-seven variations were observed in these patients. They included aberrant right subclavian artery in seven patients, bovine arch in one patient, bovine origin of left vertebral artery from arch in one patient, bronchial artery of anomalous origin from arch in one patient, double aortic arch in one patient, and right-sided aortic arch in 16 patients. ConclusionThe variant anatomy of the aortic arch has tremendous clinical significance, especially from the surgical standpoint. Anatomical variants can also cause difficulty during catheterization while performing endovascular interventions. Given the prevalence demonstrated in our study, imaging may be indicated prior to any procedure involving vascular access in order to prevent unwanted complications.

Anomalous origin of the left vertebral artery from the arch of the aorta

Introduction. Although there are lots of varieties of aorta arch, they seem to appear relatively rarely. Anomalies of aortic arch departures are mainly concerned with its location, course, the place of departure and number of its main branches. However, they warrant attention due to their importance in operative, diagnostic, and endovascular procedures. Aim. We want to present here a case of a female cadaver with rare aortic arch origin of the left vertebral artery. The aim of this article is to complete the frame of anomalies in aortic arch and to explore rare variability shown in this specific case. Description of the case. The present report describes an anomalous case of the left vertebral artery arising from the aortic arch between the left common carotid artery and the left subclavian artery in a female cadaver during dissection in an anatomical laboratory. Aortic origin of the vertebral artery is a rare anatomic variant. Conclusion. Thorough knowledge of anomalous origin is important for patients who undergo operation of an aortic arch or inferior part of the neck. Normally, the vertebral artery arises from the first part of the subclavian artery on both sides.

Association of aberrant subclavian arteries with aortic pathology and proposed classification system

ObjectiveAberrant subclavian artery (aSCA) is a rare anatomic variant whose association with other aortic branch variations and aortic pathology has yet to be established. Knowledge of such an association could be relevant to recommendations for screening and awareness as associated variations are important for operative planning. We describe the incidence of aSCA variations, its association with aortic pathology, and a proposed classification system. MethodsThe thoracic cross-sectional imaging database at Keck Hospital of the University of Southern California from 2006 to 2018 was queried for presence of aSCA. Studies were evaluated for aSCA laterality, variant anatomy, and aortic and branch vessel disease. Medical records were reviewed for associated symptoms and diagnoses. The primary outcome was association of aSCA with aortic pathology (aneurysm or dissection). Secondary outcomes were comparison of right and left aSCA, comparison between the sexes, and creation of a proposed classification system. ResultsOf 98,580 axial imaging studies, 810 studies (0.82%) were identified with aSCA in 312 unique patients. Right aSCA made up the majority of cases (90.1%). All aSCAs had a retroesophageal course. Kommerell’s diverticulum (KD) was present in 184 (59%) with an average diameter of 1.67 cm (range, 1.2-3.3 cm). KD was more frequent (84% vs 56%; P = .0003) and larger (2.05 cm vs 1.61 cm; P < .0001) in left aSCA patients. When present, KD was more often symptomatic in left aSCA compared with right aSCA (77.4% vs 49.1%; P = .005). Dysphagia, chest pain, reflux, and asthma were all more common in left aSCA patients. KD was also more common in men (73.3% vs 50%; P < .0001) and larger in men (1.81 cm vs 1.54 cm; P < .0001) but with no difference in symptoms between sexes. Our proposed classification system based on aortic arch branching is as follows: type 1, left arch with right aSCA (59.9%); type 2, left arch with common carotid trunk and right aSCA (30.1%); type 3, right arch with left aSCA (9.6%); and type 4, right arch with common carotid trunk and left aSCA (0.3%). Subtypes describe the right vertebral artery (RVA) and left vertebral artery (LVA) origin: subclavian (s, RVA 90.1%, LVA 96.8%), carotid (c, RVA 9.6%, LVA 0.3%), or arch (a, RVA 0.3%, LVA 2.9%). Overall, 9.9% (31/312) had associated aortic pathology, although the study was underpowered to detect a difference between right aSCA and left aSCA (9.3% vs 16.1%; P = .213). Type 3 and type 4 arches more often have associated aortic pathology, KD, and symptoms. ConclusionsaSCAs are frequently symptomatic and commonly associated with aortic dissection and aneurysm. Our proposed classification scheme depicts all four aSCA arch variants and accounts for vertebral artery origin variation. These variants are common, and vertebral anatomy can differ greatly. Knowledge of these anatomic variations is critical to planning for endovascular and open repair of aortic arch pathology.

Aberrant Origin of Left Vertebral Artery From Left Common Carotid Artery in Association With Tetralogy of Fallot and Anomalous Aortic Origin of Left Pulmonary Artery

Aberrant Origin of Left Vertebral Artery From Left Common Carotid Artery in Association With Tetralogy of Fallot and Anomalous Aortic Origin of Left Pulmonary Artery

Clinically Relevant Variations in the Branching Pattern of Arch of Aorta - Research Article

Anatomical variations in the branching pattern of arch of aorta are significant for diagnostic, surgical, and interventional procedures of the thorax and neck and the aim of the study is to analyze the anatomical variations in the branching pattern of arch of aorta. The purpose of this study is to review the anatomical variations in branching pattern of arch of aorta in fifty adult human cadavers (M: 42, F: 8) dissected in the department of anatomy, Siddhartha medical college, Vijayawada for five consecutive years from 2013 to 2017. The three branches of the arch of aorta were normal in 41 cadavers in the present study. In 9 cadavers, the variations were observed. In five male cadavers and in a female cadaver, the two branches of arch of aorta were the common trunk of brachiocephalic trunk and left common carotid artery and the left subclavian artery. In two male cadavers, the branches were four including the origin of left vertebral artery from arch of aorta. In a female cadaver, the three branches of arch of aorta were as follows: common trunk of brachiocephalic trunk and left common carotid artery, the left vertebral artery and the left subclavian artery. Head and neck surgeons and interventional radiologists should be aware of aortic arch variations. Computerized tomography angiography is a reliable imaging method for demonstrating anatomical features and variations of the arch of aorta.

Variable origin of vertebral artery : A Cadaveric and Multidetector computed tomographic study on Indian population

Abstract Background: The knowledge of normal and variant anatomy of vertebral artery is important for the interpretation of vascular radiology and in performing safe vascular procedures like repair of aneurysms, excision of craniocervical junction masses &amp; vertebral endarterectomy. Aim: To find out incidence of left vertebral artery of aortic origin in North Indian population. Materials &amp; Method: During routine dissection of thoracic region, an anatomical variation of origin of left vertebral artery of aortic origin was observed in adult male cadaver. To find out incidence of left vertebral artery of aortic origin in North Indian population, Radiological study was done on 100 patients [34 female + 66 males] who were advised computed tomography of neck &amp; thorax for various indication. Diameter of left vertebral artery at origin from arch of aorta and where it entered foramen transversarium was measured. Length of VI segment i.e. from its origin to where it entered foramen transversarium was also measured. Result: Out of 100 patients, left vertebral artery of aortic origin was observed in 4 patients. Conclusion: Aortic origin of vertebral artery is of diagnostic importance prior to surgery in neck &amp; chest regions. Cadaveric metrological studies are also helpful to design aortic stent

Prevalence and Types of Aortic Arch Variants and Anomalies in Congenital Heart Diseases

Aortic arch (AA) variants and anomalies are important to recognize in patients with congenital heart disease (CHD) before surgery or intervention. The aim was to study the prevalence of AA anomalies and variants in patients with CHD compared to a control group. The secondary outcome was to report the associations between common variations of AA and specific types of CHD. After institutional review board approval, computed tomography studies of 352 CHD patients and control group of 400 consecutive computed tomography scans of the thorax were evaluated. The AA was assigned to one of seven common types, and their distribution was compared between CHD and control. The distribution of the AA anomalies and variants was evaluated as regard specific types of CHD and the visceroatrial situs. Normal three-vessel branching pattern was the commonest in both groups, but was present in only 50.5% in the CHD compared to 68.5% in the control group, p < 0.00001. Right AA and aberrant right subclavian artery were significantly more common in CHD than control group (18.1% versus 0.25%, p < 0.00001) and (4.5% versus 0.25%, p = 0.0001), respectively. Direct aortic origin of left vertebral artery was insignificantly more common in CHD group (4.2% versus 2.7%, p = 0.258). Brachiobicephalic trunk was significantly more common in control than CHD group (27.7% versus 19.3%, p = 0.007). Normal three-vessel AA was significantly less common in CHD. AA anomalies (right arch and aberrant right subclavian) were more common in CHD than control, while AA variants (brachiobicephalic trunk and direct aortic origin of left vertebral artery) were not.

Aortic Origin of Left Vertebral Artery: A Case Report

Aortic Origin of Left Vertebral Artery: A Case Report

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.

MDCT Evaluation of Variations in branching patterns of aortic arch: Study of 830 Indian patients

Objectives : The aim was to determine the prevalence of various variations in the branching pattern of the aortic arch. Material and Methods : 830 Indian patients were included in the study, who had undergone neck and chest CT between Dec 2015 and May 2016, with the exclusion of patients with congenital cardiac anomalies. Results : Of 830 patients, 694 (83.6 %) patients were observed to have the classic three-vesseled branching pattern of the aortic arch, i.e. the brachiocephalic trunk, left common carotid artery and left subclavian artery arising from right to left, with brachiocephalic trunk further dividing into right common carotid and right subclavian arteries. Variations in branching pattern were seen in the remainder 136 (16.3 %) patients. It was also noted that out of the 136 patients with variant branching patterns, 91 (66 %) were females, and the rest were males. The most common variation was the origination of the left common carotid artery from the brachiocephalic trunk, i.e. two-vesseled arch , which was observed in 79 (9.5 %) cases. In 26 (3.1 %) cases, four-vesseled arch was seen, which is direct origin of left vertebral artery from the aorta. 5 (0.6 %) patients had aberrant right subclavian artery . Conclusions : Variations in the branching pattern of the aortic arch are quite common. It is especially important that head and neck surgeons and interventional radiologists should be aware of these aortic arch variations. Contrast-enhanced CT imaging is a reliable method for demonstrating anatomical features and variations of the aortic arch.

Anomalous origin of left vertebral artery from arch of aorta and associated vascular anomalies – A case report

Anomalous origin of left vertebral artery from arch of aorta and associated vascular anomalies – A case report

ANOMALOUS LEFT VERTEBRAL ARTERY FROM ARCH OF AORTA: A THOUGHT FOR SURGEONS?

Address for Correspondence: Dr. Deepa Somanath, Assistant Professor, Dept. of Anatomy, Sri Manakula Vinayagar Medical College, Madagadipet, Puducherry605 107, India. E-Mail: deepa.somanath@gmail.com *1 Assistant Professor, Dept. of Anatomy, Sri Manakula Vinayagar Medical College, Puducherry, India. 2 Post Graduate Student, Dept. of Anatomy, Sri Manakula Vinayagar Medical College, Puducherry, India. Arterial variations in the branching pattern of arch of aorta are uncommon and may occur as a result of developmental changes in the fusion and absorption of various pharyngeal arch arteries into the aortic sac. The present case report describes a finding in a male cadaver aged between 6065 years about the origin of left vertebral artery directly from the arch of aorta. Such variations should be kept in mind during surgical procedures in the superior mediastinum.