Variations In Branching Pattern Research Articles

Variations in branching pattern of arch of aorta in Gujarat region

Variations in branching pattern of arch of aorta in Gujarat region

Anatomical variation in bifurcation and trifurcations of sciatic nerve and its clinical implications: in selected university in Ethiopia.

BackgroundThe Sciatic nerve is the widest nerve of the body. It consists of two components, namely: the tibia and the common peroneal components derived from the ventral rami of L4 to S3 spinal nerves of the lumbosacral plexus. It exits the pelvis through the greater sciatic foramen below the Piriformis muscle and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. The purpose of this study is to identify the course and variations in branching pattern of the sciatic nerve which may lead to various clinical manifestations.MethodsTwenty-eight formalin fixed cadavers comprising of 56 lower limbs are used for this study, of which six specimens were female cadavers. Dissection of gluteal region and posterior compartment of the thigh was done to expose the sciatic nerve. Variations in the sciatic nerve anatomy; their relationship to Piriformis muscle and a point of bifurcation and trifurcation were noted and recorded.ResultsForty-two lower limbs (75 %) showed normal anatomy of sciatic nerve. Fourteen regions (25 %) showed variations in the sciatic nerve, of which six regions (11 %) showed a variation of the sciatic nerve in relation to Piriformis muscle, three regions (5 %) showed trifurcation of the sciatic nerve and five regions (9 %) showed variation in the origin of the sural nerve.ConclusionThe knowledge regarding the level of division and distribution of the sciatic nerve and its location is of great importance. The sciatic nerve is frequently involved in daily medical practice of neurology, orthopedics, rehabilitation and anesthesia. Its long course makes it vulnerable to nerve injury. Even in this era the cadaver is the best means to study anatomy. It emphasizes proper clinical implications, for the surgeons to practice efficient surgical recombination and avoid errors.

Variation in branching pattern of dorsalis pedis artery

Variation in branching pattern of dorsalis pedis artery

Portal vein variations in 1000 patients: surgical and radiological importance.

The purpose of the study was to evaluate the spectrum and incidence of intrahepatic portal vein (PV) variations on triphasic abdomen multidetector CT (MDCT) and to discuss the surgical and radiological implications. A retrospective review of 1000 triphasic MDCT abdomen scans was performed in patients sent for various liver and other abdominal pathologies between January 2014 and August 2014. A total of 967 patients (N = 967) were included in the study. The variations in branching pattern of PV were classified according to classification used by Covey et al (Covey AM, Brody LA, Getrajdman GI, Sofocleous CT, Brown KT. Incidence, patterns, and clinical relevance of variant portal vein anatomy. AJR Am J Roentgenol 2004; 183: 1055-64) and Koç et al (Koç Z, Oğuzkurt L, Ulusan S. Portal vein variations: clinical implications and frequencies in routine abdominal CT. Diagn Interv Radiol 2007; 13: 75-80). Normal anatomy (Type I) was seen in 773 patients (79.94%) out of 967 patients in our study. Trifurcation (Type II) anomaly was seen in 66 (6.83%) of cases. Right posterior vein as first branch of main PV (Type III) anomaly was seen in 48 (4.96%) of cases. Type IV anomaly and Type V anomaly was seen in 26 (2.69%) and 13 (1.34%) cases, respectively. 19 cases showed other types of variations. Variations in the hepatic PV branching patterns are commonly seen that are similar to variations in hepatic artery and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists. Awareness of the variations in PV branching patterns is essential for intervention radiologists and vascular surgeons and avoids major catastrophic events.

The morphometric study of the normal and variant branching pattern of the Aortic arch by cadaveric dissection

Introduction: A thorough knowledge of the anatomy of the arch of aorta and its branches is of great importance today as the arch is assuming a key role in many endovascular surgeries. The varying configuration of the arch and its branching pattern are one of the main risk predictors in many endovascular surgeries such as carotid artery stenting. Methods: In the present study, the morphology and the morphometry of the aortic arch and its branches has been studied on 35 embalmed human cadavers. Results: The arch showed variant branching pattern in 11.43% cadavers. In variations, the arch was found to give rise to only 2 branches in 3 cadavers and 4 branches in 1 cadaver as against normal pattern of 3 branches. The brachiocephalic trunk, the left common carotid artery and the left subclavian artery had mean outer and inner diameters as 13.22 mm and 10.8 mm, 8.06 mm and 6 mm and 9.95 mm and 8.38 mm respectively. In 28.5% specimens the brachiocephalic trunk originated on the left of the mid-vertebral plane. Conclusion: The arch morphology is variable and becomes more so with the advancing age. Advanced non invasive radiological angiographic procedures such as, 3 dimensional CT scan or MRI have limitations in understanding actual three dimensional structure of these vessels. Thus in this era of increasing vascular invasive procedures the knowledge gained from this study will be useful to the cardiologists, cardiothoracic surgeons and radiologists in various diagnostic and therapeutic procedures, to manipulate within these vessels.

Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy.

Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot's triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries.

Bilateral anatomical variation in branching pattern of external carotid artery in a male cadaver - a case report

AbstractDevelopmental anomalies in the origin and branching pattern of the external carotid artery are not common. The level of the bifurcation of the common carotid artery and also the variations in the origin/branching pattern of the external carotid artery are well known and documented. During a routine dissection of middle aged male cadaver in department of Anatomy in BP Koirala Institute of Health Sciences (BPKIHS) The clinically-relevant variations to be noted were the high origin and anomalous course of the facial artery, superior thyroid artery arising as a branch of Common Carotid artery, high origin of ascending pharyngeal artery, posterior auricular artery and direct glandular branches to the Submandibular gland. Such anatomical variations of external carotid artery are important for surgeons in surgeries of head and neck region and also for radiologists in the image interpretation of the face and neck region.

Angiographic evaluation of branching pattern and anatomy of the aortic arch

The study aimed to investigate anatomical variations in branching pattern and anatomy of the aortic arch, and the prevalence of each type. Between September 2011 and November 2013, angiographic studies of 270 patients (144 male, 126 female) were analyzed retrospectively for variations in branching pattern and anatomy of the aortic arch. Patient mean age was 59.8 years (range, 13-88). Branching variations were found and divided into subtypes. Patients were also classified according to arch anatomy. Incidence of variations and types of aortic arch were statistically analysed. Analysis of the 270 patients revealed six types of branching pattern. Type I, classical pattern arch with three branches (TB, LCC, LS), was observed in 198 cases (73.3%). Type II (bovine arch), the most commonly observed variation, in which LCC originates from TB, was observed in 58 cases (21.5%). Type III, in which the left vertebral artery arises from the arch, was seen in seven cases (2.6%). Type IV, a combination of types II and III, was observed in three cases (1.1%). Type V, common origin of common carotids, LS and aberrant RS, was found in three cases (1.1%). Type VI (avian type), arch with only two branches, was observed in one case (0.4%). When patients were classified according to aortic arch anatomy, Type 1, Type 2 and Type 3 were observed in 195, 40 and 35 patients respectively. Knowledge of the variations and anatomy of the aortic arch is essential during interventional procedures and neck-thorax surgery.

Rare atypical vascular pattern of subscapular artery: Anatomico-clinical insight.

The use of muscles of scapular region in transposition and reparative surgery has made the anatomical knowledge of axillary artery and its branches imperative. The subscapular arterial tree is frequently used as a source of microvascular grafts to replace damaged or diseased portion of arteries especially in upper and lower limbs. This investigation is aimed to study the variation in branching pattern of the third part of axillary artery. Routine educational cadaveric dissection of a young adult Indian male cadaver. The present article highlights a rare variation of the subscapular artery and its branches. The subscapular artery displayed a unique pattern of trifurcation. Its branches were seen supplying serratus anterior, subscapularis, latissimus dorsi and teres major muscles. The study focuses on a new variation of the subscapular artery which could prove useful for interventional radiologists and surgeons in reconstructive surgeries.

Study of anatomical variation and branching pattern of the femoral nerve in 25 cadavers

Backgrouns: Femoral nerve is used for nerve block in several surgeries. The knowledge of femoral nerve in thigh is important for anatomist, anesthetics, and surgeons to prevent iatrogenic femoral nerve palsy. We dissected 25 human cadavers to study the anatomy of femoral nerve. We dissected the femoral nerve bilaterally in Anatomy Department of Smt N H L Municipal Medical College, and recorded the branching pattern of femoral nerve with digital photography. Objective: To highlight the variation in branching pattern of the femoral nerve. Materials and Methods: We measured the distance from the anterior superior iliac spine (ASIS) to the pubic symphysis bilaterally on each cadaver as an anatomical landmark. We located the femoral nerve through transverse incisions from the ASIS to the pubic symphysis and incisions originating from the midpoint between the ASIS and the pubic symphysis extending longitudinally to the patella. We chose the inguinal ligament as a proximal limitation for dissection of the femoral nerve in the thigh. The distance from the inguinal ligament to the first branching point of the femoral nerve was measured. We traced and dissected all femoral nerve branches to the insertion points. Result: The mean medial–lateral distance from the ASIS to the pubic symphysis was 14.50 ± 1.34 cm (range 13–16). We found the femoral nerve near the midpoint, 46± 5% from the ASIS. We did not measure in cadaver specimen 5 since bony landmarks were difficult to palpate because of excessive adipose tissue. The distance from the inguinal ligament to the first branching point of the femoral nerve was 1.50 ± 0.47 cm (range 1–2cm). Conclusion: The anatomy and morphology we observed remained consistent with the established literature, suggesting that our chosen specimens did not differ from the standard population and that we may consider the results representative of the general population.

Treatment with Aortic Stent Graft Placement for Stanford B-Type Aortic Dissection in a Patient with an Aberrant Right Subclavian Artery.

A 71-year-old man visited our hospital with the chief complaint of back pain and was diagnosed with acute aortic dissection (Debakey type III, Stanford type B). He was found to have a variant branching pattern in which the right subclavian artery was the fourth branch of the aorta. We performed conservative management for uncomplicated Stanford type B aortic dissection, and the patient was discharged. An ulcer-like projection (ULP) was discovered during outpatient follow-up. Complicated type B aortic dissection was suspected, and we performed thoracic endovascular aortic repair (TEVAR). The aim of operative treatment was ULP closure; thus we placed two stent grafts in the descending aorta from the distal portion of the right subclavian artery. The patient was released without complications on postoperative day 5. Deliberate sizing and examination of placement location were necessary when placing the stent graft, but operative techniques allowed the procedure to be safely completed.

Variations in the popliteal artery branching in 342 patients studied with peripheral CT angiography using 64-MDCT.

The objective of this study was to assess the utility of peripheral computed tomography angiography (CTA) using 64-multidetector computed tomography (64-MDCT) in the detection of variations in branching patterns of the popliteal artery. The peripheral CTAs of 742 limbs in 342 patients who underwent peripheral CTA using 64-MDCT of the lower extremity due to various reasons were retrospectively reviewed. The anatomical variations in popliteal artery branching were assessed in 636 limbs from the same cohort of patients. Five hundred fifty-three (87 %) limbs had the usual branching pattern (type IA). Variations in the branching pattern of the popliteal artery were seen in 83 (13 %) limbs. The most common anatomical variation was trifurcation of the popliteal artery in 27 (4.2 %) limbs, with anterior tibial, posterior tibial, and peroneal arteries arising together with no true tibioperoneal trunk (type IB). The presence of variations in the anatomy of the popliteal artery could be of radiological and surgical importance in orthopedic interventions and various vascular surgery procedures. Peripheral CTA using MDCT is a suitable imaging modality for noninvasive evaluation of lower extremity arteries, and it may become the preferred method for evaluating variations in popliteal artery branching.

Variations in the Branching Pattern of the Aortic Arch Detected with Computerized Tomography Angiography

Objectives. The aim was to determine the prevalence of aortic arch variations in 881 patients who underwent neck CT angiography for various reasons. Material and Methods. 881 patients were included in the study who had undergone neck CT angiography between 2010 and 2013. Results. Of 881 patients, 770 (87.4%) patients with classic branching pattern of the aortic arch (AA) were observed. Variations in branching pattern were seen in 111 (12.6%) patients. The most common variation was the origination of the left common carotid artery (LCCA) from the brachiocephalic trunk (BCT). This pattern was observed in 64 (7.2%) cases. In 25 (2.8%) cases, the left vertebral artery (LVA) originated directly from the AA between the origin of the LCCA and left subclavian artery (SCA). 17 (1.9%) cases had aberrant right subclavian artery. Three (0.3%) cases showed right aortic arch. Two cases had right aortic arch with aberrant left subclavian artery. Conclusions. Variations in the branching pattern of the AA are not rare. Head and neck surgeons and interventional radiologists should be aware of aortic arch variations. CTA is a reliable imaging method for demonstrating anatomical features and variations of the AA.

Bilateral anatomical variation in branching pattern of external carotid artery in a male cadaver: A case report

Developmental anomalies in the origin and branching pattern of the external carotid artery are not common. The level of the bifurcation of the common carotid artery and also the variations in the origin/branching pattern of the external carotid artery are well known and documented. During a routine dissection of middle aged male cadaver in Department of anatomy of BP Koirala Institute of Health Sciences. The clinically-relevant variations to be noted were the high origin and anomalous course of the facial artery, superior thyroid artery arising as a branch of Common Carotid artery, high origin of ascending pharyngeal artery, posterior auricular artery and direct glandular branches to the submandibular gland. Such anatomical variations of external carotid artery are important for surgeons in surgeries of head and neck region and also for radiologists in the image interpretation of the face and neck region.

Anticlockwise swirl of mesenteric vessels: A normal CT appearance, retrospective analysis of 200 pediatric patients

ObjectiveThe counterclockwise rotation of the SMV on SMA is a normal and non-specific finding, which results in an incomplete swirl formation on CT scans. However, it has a potential to be misinterpreted as ‘midgut volvulus’ resulting in serious clinical implications. The study was done to determine the frequency and degree of counterclockwise rotation of the SMV on SMA on CT in normal otherwise asymptomatic pediatric patients undergoing CT scan. MethodsIn this IRB approved study, we retrospectively analyzed abdominal CT scan examinations of 200 consecutive pediatric patients (age range of 11 days to 18 years), which were performed for different clinical indications over a period of 10 months. They were evaluated for the absence or presence and degree of counterclockwise rotation of the mesenteric vessels. ResultsOf the 200 patients, 128 (64%) patients showed no clockwise or anticlockwise rotation of mesenteric vessels. Counterclockwise rotation of SMV on SMA was seen in 72 (36%) patients. Further, the degree of rotation of vessels was also calculated, based on the criteria proposed by the authors. ConclusionsThe counterclockwise rotation of SMV on SMA gives an appearance of mesenteric whirlpool in otherwise normal mesenteric vessels and can be misinterpreted as midgut volvulus. It is a normal CT appearance and is due to a variation in branching pattern of mesenteric vessels. Awareness of this normal branching pattern of mesenteric vessels is important to avoid an inadvertent laparotomy.

Thoracic part of sympathetic chain and its branching pattern variations in South Indian cadavers.

The sympathetic trunks are two ganglionated nerve trunks that extend the whole length of the vertebral column.The two trunks end by joining together to form a single ganglion, the ganglion impar. The thoracic part of the sympathetic chain runs downward and leaves the thorax behind the medial arcuate ligament. The preganglionic fibers which are grouped together to forms planchnic nerves and supply the abdominal viscera. Anatomical variations of the thoracic sympathetic trunk in relation to intercostal nerves may be one of the reasons that cause surgical failures. Therefore, our present study aimed to investigate the sympathetic variations in the cadavers. In the present study we have investigated 31 embalmed cadavers thoracic cavities were eviscerated, the posterior thoracic walls were dissected carefully to expose the sympathetic chain and its branches. Stellate ganglion was observed bilaterally in 4 cadavers and unilaterally in 15 cadavers. Greater splanchnic nerve highest origin was 4(th) ganglion and the lowest origin was 11(th) ganglion. Common origin for the lesser splanchnic nerve was from the 11(th) ganglion. Common origin for the least splanchnic nerves was from the 12(th) ganglion. Information on the variability of the anatomy of the thoracic sympathetic chain and splanchnic nerves may be important for the success of subdiaphragmatic neuroablative surgical approaches to pain control and splanchnic neurectomy for the management of chronic abdominal pain.

Bleeding from aberrantly originating left gastric artery diagnosed by computed tomography scan

Introduction: Variations of branching pattern of the celiac trunk are well documented. Left gastric artery takes origin directly from the aorta in 0.5-15% of cases. bleeding from such artery is rarely reported in literature. this type of rare variation has significant importance in surgical and radiological procedures. Herein, we describe a case of bleeding from a variant left gastric artery. case report: A 56-year-old male was admitted to our hospital with weight loss for endoscopic fine-needle aspiration of splenic abscess. Following fine-needle aspiration the patient had gastric bleed which was diagnosed by contrast-enhanced computed tomography (cEct) scan and abdominal angiography. the cEct scan of abdomen also revealed the variant left gastric artery which was source of bleeding. Upper gastrointestinal endoscopic was done and hemostasis was achieved by applying endoclip. conclusion: Anatomical knowledge of variation is important for management of bleeding from such aberrant artery.

Unilateral multiple variations of renal, phrenic, suprarenal, inferior mesenteric and gonadal arteries

Knowledge of the branching pattern of the abdominal aorta is clinically important for any abdominal surgeon operating on parts of the gut or neighboring structures. Variations of these vessels may influences urological, renal transplantation and laparoscopic surgeries. We present an unreported case of multiple variations of branching pattern of abdominal aorta. It includes double renal arteries for left kidney, a common trunk with right and left phrenic, right and left superior suprarenal and left middle supra renal arteries, and a common trunk originate 2.5 cm above the bifurcation of abdominal aorta gave off inferior mesenteric, accessory renal artery to the left kidney and left testicular arteries in the middle-aged normal male cadaver. The embryogenesis of such multiple variations of branches of abdominal aorta is not clear, but the anatomic consequences may have important clinical implications. Knowledge of these variations is important for urologists, radiologists and surgeons in general.

Variant Branching Pattern of the Right Internal Iliac Vessels in A Male - A Case Report

Internal iliac vessels show frequent variations in their branching pattern. We saw variations in the branching pattern of right internal iliac vessels in a male cadaver. The internal iliac artery did not divide into anterior and posterior divisions. There were three common trunks: one for iliolumbar and lateral sacral arteries, another for inferior gluteal and internal pudendal arteries, and the third one for superior vesical and obturator arteries. The superior gluteal and middle rectal arteries arose directly from the main trunk of the internal iliac artery. The internal iliac vein did not have a main trunk. Its anterior and posterior divisions joined with the external iliac vein to form the common iliac vein. Knowledge of these variations might be useful for the urologists and surgeons.

English

English