Origin Of Vertebral Artery Research Articles

Direct Aortic Origin of the Left Vertebral Artery in Two Adult Female Cadavers

BackgroundThe vertebral artery (VA) is a branch of the aortic arch which usually arises from the posterosuperior aspect of the first part of the subclavian artery and ascends medially to the transverse process of the seventh cervical vertebra and continues ascending through the transverse foramina of the upper six cervical vertebrae to enter the skull via the foramen magnum. It is an important blood supply of the spinal cord, vertebral muscles, hindbrain and contribution to the circle of Willis.ResultsDuring routine dissection of the superior mediastinum and neck of two adult female cadavers the left VA was observed originating directly from the aortic arch rather than the left subclavian artery. In one cadaver the left VA entered the transverse foramen of the fifth cervical vertebra (CV5), while in the other cadaver it entered the typical the sixth cervical vertebra (CV6) transverse foramen. The diameter and length of the vessel that entered CV5 maintained the same diameter of 5mm from its origin to its position on the posterior arch of the atlas and measured 95mm in length from its origin to its entrance at CV5. In the other cadaver, the diameter decreased from 4mm, at its origin, to 3mm as it entered CV6. As it ascended from its origin it took a highly coiled approach and measured 60mm in length from its origin to it entrance in CV6. Direct aortic origin of the left vertebral artery is the most frequent anatomic variant of the vertebral artery with an incidence ranging from 2.4–5.8%.ConclusionKnowledge of this variation is important to reduce the risk of vertebral artery injury in angiography and surgical approaches.Support or Funding InformationCenter for Anatomical Science and Education, Department of Surgery, Saint Louis University School of MedicineThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Risk Factors for Restenosis After Stenting or Angioplasty of Vertebral Artery Origin : Results of Short-term and Long-term Follow-up.

Endovascular treatment represents awell-established therapeutic option in patients with vertebral artery origin (VAO) stenosis. Our aim was to determine which factors affect short- and long-term restenosis rates after endovascular VAO therapy. We conducted asingle center analysis of 52patients (36men; age 64 ± 9.54 years) who underwent 55endovascular procedures (27balloon-assisted angioplasty [BAA], 28stent-assisted angioplasty [SAA]) between 2005-2015. We collected data on patients clinical characteristics, medication and post-interventional follow-up visits. Overall, 15of 55vessels (27%) showed ≥70% restenosis at 1year (short-term follow-up) and 18after amean follow-up of 52.9 ± 31.8months (long-term). BMI ≥ 25 kg/m2 was associated with ≥70% restenosis in short-term (P = 0.014) and long-term (P = 0.003) follow-up. Other risk factors, namely, hypertension, ischemic heart disease, smoking, diabetes mellitus, hypercholesterolemia, atrial fibrillation, CRP (>5 mg/l) or pre-treatment antiplatelet administration, statin intake and platelet count, were not associated with restenosis risk in the entire cohort or in patients in the BAA group (all P > 0.05). BMI (P = 0.003) and ischemic heart disease (P = 0.041) were, in turn, associated with restenosis risk in the long-term follow-up in the SAA group. Patients undergoing BAA developed less frequently (P = 0.032) restenosis (18%) during long-term follow-up as compared to patients treated by stenting (46%). BMI ≥ 25 kg/m2 increases the odds for ≥70% restenosis of VAO while ischemic heart disease represents an additional risk factor in stented patients. Further studies are required to established therapeutic strategies lowering the restenosis rates in overweight individuals after VAO therapy, especially ones undergoing stenting.

Anatomical and radiological evaluation of the variation in the branching patterns and morphology of the aortic arch in the irish population- A morphometric study

Introduction: Anatomical variations of the aortic arch are clinically significant for diagnostic and surgical procedures in the mediastinum. Our objective was to determine the arch morphology and incidence of variant branching patterns in both a cadaveric and patient population. Materials and Methods: 194 CT scans were retrospectively analysed for branching variations and arch type. 18 cadavers were dissected with variations noted. Results: Analysis of scans revealed normal branching in 77.32%, bovine arch pattern in 14.43%, direct origin of the left vertebral artery in 7.73% and a bovine arch with direct origin of the left vertebral artery in 0.52%. A significant correlation (p<0.0001) was found between arch type and age, with the mean age of a type 1 arch 51.1 years, type 2 arch 60.7 years, and type 3 arch 70.7 years. Direct origin of the left vertebral artery was found in one cadaver. Conclusion: Correlation between arch type and age strengthens the concept of age-related unfolding of the aortic arch. A detailed understanding of the branching variations of the arch is important in the disciplines of anatomy, radiology and cardiothoracic surgery.

Two cases of dual origin left vertebral arteries with non-convergence

In typical human anatomy, the vertebral arteries (VA) originate from the subclavian arteries (SCA) and enter the transverse foramen of the sixth cervical vertebra (C6). The reported frequency of deviations vary, but the clinical significance of a more medial location of aberrant LVAs result in a need to understand their frequency in the population, as well as any coexisting vascular variations. Here we reported 2 cases of variant left vertebral arteries that entered the transverse foramen of the C4 vertebra and continued to the brain. Both presented with a second vessel entering the C6 transverse foramen, suggesting a dual origin of the left vertebral artery, but in neither case did the two vessels converge. These findings suggest a higher frequency of occurrence of this anatomical variation, and demonstrate the continued importance of cadaver-based anatomical study.

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.

A Very Rare Origin of the Left Vertebral Artery and its Clinical Implications

A Very Rare Origin of the Left Vertebral Artery and its Clinical Implications

Compressed Amplatzer Vascular Plug II Embolization of the Left Subclavian Artery for Thoracic Endovascular Aortic Repair is Efficient and Safety Method Comparable to Conventional Coil Embolization

Left subclavian artery (LSA) embolization is occasionally required to prevent type II endoleak in the thoracic endovascular aortic repair (TEVAR) procedure. This is a retrospective study comparing compressed Amplatzer Vascular Plug II embolization (CAE) and conventional coil embolization (CCE) in preventing retrograde flow into the aneurysmal sac through the LSA after TEVAR. We retrospectively reviewed the records of patients who underwent CAE or CCE of the LSA during TEVAR from June 2013 to March 2016 in our hospital. The efficacy, safety and cost of each method were compared between two groups. Thirty patients underwent LSA embolization during TEVAR. Six CCEs in 6 patients were performed from June 2013 to November 2013, while twenty-four CAEs in 24 patients were performed from December 2013 to March 2016. Technical success was achieved in all patients in both groups. No embolization-related complications or type II endoleaks from LSA were recorded during the follow-up period in all patients. In both groups, all embolic materials were detected in the proximal portion of the LSA from the LSA orifice to the vertebral artery origin and no vertebral artery occlusions were detected. The mean compression ratio of AVP II was 58 ± 5.9% of predicted length of standard procedure. In the CAE group, one AVP II was sufficient to achieve complete LSA occlusion in all patients. On the other hand, multiple coils (10.2 ± 2.7) were used in the CCE group (P < .01), resulting in a significantly lower cost incurred in the CAE group (CAE: 129,000 JPY vs. CCE: 639,600 ± 140,060 JPY; P < .01). The CAE is a useful and cost-effective procedure for TEVAR-related LSA embolization.

An unusual origin and course of the thyroidea ima artery, with absence of inferior thyroid artery bilaterally.

We report an unusual origin and course of the thyroidea ima artery in a male cadaver. The ima artery originated from the right subclavian artery very close to origin of the right vertebral artery. The artery coursed anteriorly between the common carotid artery medially and internal jugular vein laterally. It then coursed obliquely, from below upwards, from lateral to medial superficial to common carotid artery, to reach the inferior pole of the right lobe of thyroid and branched repeatedly to supply the anteroinferior and posteroinferior aspects of both the thyroid lobes and isthmus. The superior thyroid arteries were normal. Both the inferior thyroid arteries were absent. The unusual feature of this thyroidea ima artery is its origin from the subclavian artery close to vertebral artery origin, the location being remarkably far-off from the usual near midline position, and the oblique and relatively superficial course. This report is a caveat to neck surgeons to consider such a superficially running vessel to be a thyroidea ima artery.

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.

Incidence and Predictors of the In-stent Restenosis after Vertebral Artery Ostium Stenting

BackgroundThe incidence and predictors for in-stent restenosis (ISR) was not fully explored. We aim to investigate the incidence and predictors of ISR after stenting at the origin of vertebral artery. Materials and MethodsTwo hundred and six patients with 229 stents implantation between July 1, 2005 and July 31, 2015 were included in the study. All patients underwent conventional clinical and angiographic (digital subtraction angiography) follow-up at around 6 months post procedure. ISR was defined as greater than 50% stenosis within or immediately (within 5 mm) adjacent to the stent. Multivariate Cox regression analyses were utilized to investigate the predictors for ISR. ResultsThe ISR was found in 30 patients (30/206, 14.6%) with 31 lesions (31/229, 13.5%) with the mean follow-up duration of 11.1-month (range: 3 - 92 months). Stent diameter (hazard ratio 0.504, 95% confidence interval 0.294 - 0.864) was an independent predictor for ISR. ConclusionISR rate after Vertebral artery ostium stent placement is acceptable, which was conversely associated with the stent diameter.

Variations in origin of vertebral artery – fetal study

Variations in origin of vertebral artery – fetal study

Topography of Vertebral Artery Origin Plaques: Characteristics and Determinants

Atherosclerotic plaques located at the vertebral artery ostium (VAo) are a mechanism for posterior circulation stroke, but little is known about VAo plaque topography and formation. In this study, we describe the topography of atherosclerotic plaques involving the origin of the vertebral artery (VA). Cross-sectional analyses of extracranial duplex studies were performed, and VAo plaques were classified based on their topography in 3 groups: (1) exclusively at the VA ostium; (2) predominantly subclavian, with extension into the vertebral ostium; and (3) predominantly ostial, with extension into the subclavian artery). Chi-square and analysis of variance tests were performed to investigate the association between VAo plaque topography and continuous and categorical variables, respectively. A total of 99 of 481 (21%) ultrasound duplex studies showed VAo plaques. The majority of the plaques (60%) were found to extend from the subclavian to the ostium. Plaques occurred more frequently at the medial wall of the VAo. No vascular risk factors were associated with plaque formation; however, women were more likely to have plaques involving predominantly or exclusively the VAo (P = .004). We describe 3 different patterns of VAo involvement in patients with ostial atherosclerotic VA disease. VAo plaques occurred almost exclusively at the medial wall of the vessel. Women had more plaques involving predominantly the origin. Prospective studies are needed to investigate the clinical significance of these findings.

Evolution into Takayasu arteritis in a patient presenting with acute pulmonary oedema due to severe aortic regurgitation; a case report

BackgroundTakayasu arteritis is a rare large vessel vasculitis which predominantly affects young Asian females. Aortic regurgitation and heart failure are well described manifestations which are usually preceded by constitutional symptoms, limb claudication, pulse and blood pressure discrepancies, vascular bruits and features of organ ischaemia.Case presentationA 25-year- old Sri Lankan female presented with a three days history of acute shortness of breath, cough and orthopnoea. On examination she had severe aortic regurgitation resulting in high output cardiac failure. There was no evidence of acute coronary ischaemia or infective endocarditis. The only significant investigation finding was an elevated erythrocyte sedimentation rate (ESR) of 114 mm/first hour. The patient was treated for pulmonary oedema and empirically for infective endocarditis. Extensive evaluation for an underlying infection, large vessel vasculitis or malignancy did not reveal any abnormalities. Detailed periodic assessment identified reduced blood pressure in left arm (70/40 mmHg) compared to right (100/70 mmHg) and reduced pulse volume of left arm with left subclavian bruit more than one year after the initial presentation. Digital subtraction angiography revealed significant stenosis at first part of left subclavian and origin of left vertebral arteries. A diagnosis of Takayasu arteritis was made and patient was started on high dose glucocorticoids.ConclusionsTakayasu arteritis can present initially with isolated cardiac involvement even as acute cardiac manifestations and high degree of suspicion with close follow up would allow early detection of development of other classic features and timely diagnosis.

Prevalence and anatomy of anomalous left vertebral artery originated from aorta evaluated by computed tomographic angiography.

We evaluated anatomical characteristics and clinical significance of left vertebral artery (VA) originating from aortic arch (AA) by computed tomography (CT) angiography. CT angiography was performed in 3460 patients between March 01, 2014 and November 30, 2015. We examined course of prevertebral VA (PVVA) segment and level of entry into the cervical vertebra transverse foramen (CVTF) of left VA originated from AA. One hundred fifty-three of 3460 patients had left VA originated from AA. Six of 153 patients had dual origin of VA. Entry level to CVTF of 156 left VAs in 153 cases ranged from C3 to C6. Entry level to CVTF of 156 right VAs in 153 cases ranged from C3 to C7. One hundred fifty-six right PVVA segments positioned in longus colli muscle lateral side in 112 VAs, longus colli muscle anterior surface near longus colli muscle lateral margin in 41 VAs, and unknown location in three VAs. One hundred fifty-six left PVVA segments positioned in anterior surface of longus colli muscle midline in 5 cases, anterior surface of longus colli muscle near longus colli lateral margin in 138 cases, longus colli muscle lateral side in 12 cases, and anterior surface of anterior scalene muscle midline in one case. Left VA may arise from the AA. If a long PVVA segment entering higher CVTF is present, operator can perform anterior cervical surgery via contralateral approach for avoidance of VA injury.

Rare anomalous origin of vertebral artery with double branch: two cases report

Rare anomalous origin of vertebral artery with double branch: two cases report

Dual origin of the right vertebral artery from the right common carotid and aberrant right subclavian arteries

This report describes a case of duplicated origin of the right vertebral artery incidentally found in a young patient. Computed tomographic angiography and digital subtraction angiography showed a dominant branch derived from the right common carotid artery and an accessory branch that derived from the right subclavian artery, which aberrantly originated from the far left aortic arch, and adjoined the dominant branch at the C5 level. We discuss angiographic findings, clinical implications and embryological basis for this rare anomaly.

A right aortic arch with abnormal origin of the left vertebral artery from the left common carotid artery

A right aortic arch with abnormal origin of the left vertebral artery from the left common carotid artery

Right PICA aneurysm with anomalous origins of the right subclavian artery and right vertebral artery: findings on angiography

Anomalous origin of the right vertebral artery from the right common carotid artery (VA-CCA) with an aberrant right subclavian artery (ARSCA) is an uncommon anatomical variant. We present a series of images from a case in which this was identified on angiography for the management of a right posterior inferior cerebellar artery (PICA) aneurysm. This combination has not been previously described in the literature. The embryological mechanism of this variation, the incidence of these individual findings and the clinical implications will be discussed.

A systematic classification of the vertebral artery variable origin: clinical and surgical implications.

Several congenital anomalies regarding the right (RVA) and left (LVA) vertebral artery have been described. The current paper aims to perform a systematic literature review of the variable vertebral artery (VA) origin from the aortic arch (AOA) and its branches. The incidence of these variants and the ensuing AOA branching pattern are highlighted. Atypical origin cases were found more commonly unilaterally, while LVA presented the majority of the aberrancies. The LVA emersion from the AOA (3.6%) and the RVA from the right common carotid artery (RCCA) (0.14%) were the commonest origin variations. Aberrant RVA origin as last branch of the AOA is very rare. Eighteen cases (0.12%) with an aberrant right subclavian artery (ARSCA) were found. Among them, the RVA originated from the RCCA and right subclavian artery in 94.4 and 5.6%, respectively. Sporadic cases had an AOA origin bilaterally; RVA and LVA had a double origin in 0.027 and 0.11%, respectively. A dual origin was detected in 0.0069%, bilaterally. The atypical VA origin may coexist with: (i) an ARSCA, (ii) a common origin of brachiocephalic artery and left common carotid artery (the misnomer bovine arch) and (iii) a bicarotid trunk. The aberrant VA origin favors hemodynamic alterations, predisposing to cerebrovascular disorders and intracranial aneurysm formation. Detailed information of VA variants is crucial for both endovascular interventionists and diagnostic radiologists involved in the treatment of patients with cerebrovascular disease. Such information may prove useful to minimize the risk of VA injury in several procedures.