A retroesophageal right subclavian artery with the right vertebral artery originating from the right common carotid artery

The right subclavian artery was found to be retroesophageal, and the right vertebral artery originated from the right common carotid artery in a 46-year-old female cadaver. The right subclavian artery stemmed from the upper portion of the thoracic aorta, posterior and inferior to the origin of the normal left subclavian artery. The right and left common carotid arteries originated from the aortic arch in close proximity. Compression of the trachea anteriorly could not be demonstrated. The right inferior laryngeal nerve was nonrecurrent. A brief review of the literature shows the importance of knowledge concerning the aberrant right subclavian artery for the roentgenologist and the surgeon in the treatment of patients with this vascular anomaly.     

Fenestration and duplication of the vertebral artery

The vertebral artery (VA) acts as a foundation for the posterior circulation of the head and neck. It presents a number of anomalies that can be easily visualized thanks to modern imaging techniques, such as MR and CT angiography or color Doppler ulrasonography. Determining the appropriate terminology for those anomalies can be sometimes more challenging than their recognition. One particular challenge concerns the differentiation betweenVA fenestration and duplication. Because of the different clinical prognoses associated with those anomalies, confusion should be avoided. Knowledge of the morphological anomalies associated with the VA is important for both radiologists and head and neck surgeons, because any injury to the VA can result in a threat to the vascular supply of the brain stem, the cerebral or cerebellar hemispheres, the thalamus, cervical nerve roots and particularly the lateral medulla (Wallenberg's syndrome). This article analyses world literature concerning the issue of VA fenestration and duplication to facilitate a differential diagnosis. Clin. Anat. 26:933–943, 2013. © 2013 Wiley Periodicals, Inc.     

Quantitative anatomy of vertebral artery groove on the posterior arch of atlas in relation to spinal surgical procedures

Background The location of the vertebral artery on a groove on the superior surface of the posterior arch of atlas makes it vulnerable to injury during surgical procedures in this region. Knowledge of the quantitative anatomy of the vertebral artery groove is therefore necessary. Methods In 55 dry adult atlas vertebrae, the distance of the medial edges of the vertebral artery groove were measured from the posterior midline at both the inner and outer cortices of the posterior arch of atlas. In addition, the distance between the vertebral artery grooves on either side as well as the length of the vertebral artery groove was also measured. Results It was found that a minimum of 1.5 cm of the posterior arch could be safely exposed at both the outer and inner cortices. In addition, with mobilization of the vertebral artery from its groove on both the sides, an additional 1 cm of posterior arch could be exposed on either side. Conclusions Exposure of the posterior arch of the atlas is an important step in surgical procedures for treatment of diverse conditions of the upper spinal cord and foramen magnum region. Injury to the vertebral artery in its position on the vertebral groove may lead to disastrous complications. The present study reveals that the neurosurgeon can safely expose up to 3.5 cm of the posterior arch of atlas and knowledge of this anatomic fact may help in planning surgical approaches.     

Abnormal origin of internal thoracic and vertebral arteries

The aim of this study was to evaluate the variability of the origin of the internal thoracic and vertebral arteries after a cadaver demonstrated abnormal origins for both vessels. The arteries were studied in 60 adult cadavers and measurements taken to adjacent structures. In one cadaver the right internal thoracic artery originated from the third part of the subclavian artery (one of 120 arteries; 0.83%). The same cadaver presented with the left vertebral artery originating directly from the aortic arch between the left common carotid and left subclavian arteries. Two other cadavers also presented with abnormal vertebral arteries, making it three of 60 left vertebral arteries (5%). These results are comparable to the established range in the literature. The internal thoracic artery is used for revascularization in coronary artery diseases and as this area is also used for subclavian vein catheterization, it is important to be aware of this rare variation concerning the internal thoracic artery. This study reports an important variation in the origins of the internal thoracic and vertebral artery in a singular cadaver. Clin. Anat. 11:33–37, 1998. © 1998 Wiley-Liss, Inc.     

Bilateral variations of the vertebral arteries: The left originating from the aortic arch and the left and right entering the C5 transverse foramina

During the dissection course for second year medical students at the University of Toyama in 2005, we encountered variations of the bilateral vertebral arteries: the left directly came off from the aortic arch as the third branch between the left common carotid artery and the left subclavian artery and entered the transverse foramen of C5, instead of C6, whereas the right originated from the right subclavian artery and entered the transverse foramen of C5. The present vertebral artery of each side was possibly formed by the 6th cervical intersegmental artery linked with the longitudinal anastomoses between the cervical intersegmental arteries. Detailed knowledge of vertebral artery variations is crucially important for surgical treatment of blood vessels in the brain, neck and chest.     

锁骨下动脉、颈总动脉和椎动脉分叉处血流动力学数值模拟

目的:探讨锁骨下动脉、颈总动脉和椎动脉分叉处的血流动力学特性,分析该处发生血管狭窄引起大脑供血不足的 血流动力学原因。方法:采用内蒙古民族大学附属医院神经内科提供的CT数据,应用医学建模软件MIMICS20.0将患者 二维CT数据进行三维血管重建,经过网格划分及边界条件设置后导入计算流体力学软件FLUENT14.5中。计算和分析 不同血液入口速度的锁骨下动脉、颈总动脉和椎动脉分叉处的血流动力学特性。结果:在血液入口速度不同的情况下,锁 骨下动脉、颈总动脉和椎动脉分叉处的血液流场分布、血液压力分布和血管壁面切应力分布有显著变化。在血液入口速 度增大时,锁骨下动脉分叉处和颈总动脉分叉处的血液流速快、血管壁压力大,颈总动脉内侧血管壁面切应力大,但锁骨 下动脉分叉处和颈总动脉分叉处血管壁面切应力数值和变化幅度小,属于低切应力区。结论:通过血流动力学数值模拟 研究,分析锁骨下动脉、颈总动脉和椎动脉分叉处易发生粥样斑块病变导致大脑供血不足的血流动力学原因。     

老年人椎动脉的解剖学观测及意义

目的:为颈部推拿手法治疗提供老年人椎动脉的解剖学资料。方法:对20具老年人尸体标本椎动脉的行程、弯曲和管径等情况进行解剖学观察,并与10具年轻人尸体标本做比较。结果:老年人标本椎动脉的弯曲明显多于年轻人。多者达10余处,C2～G6段弯曲多为增生的Luscka关节向外推挤所致;左右侧椎动脉管径相差悬殊者并不少见。结论:老年人椎动脉变异较多,易受损伤。     

Anatomical study of the vertebral artery in japanese adults

The aim of the present study was to examine the vertebral arteries. The origins of the right and left vertebral arteries and their entrance points into the cervical transverse foramen were examined in dissections of 515 Japanese cadavers (303 males, 212 females) at Kurume University School of Medicine from 1990 to 2003. There were 515 right vertebral arteries and 514 left vertebral arteries. The right vertebral artery originated from the right subclavian artery in 514 of 515 arteries and one of the arteries arose from the bifurcation of the brachiocephalic trunk. The mean distance between the origin of the right subclavian artery and the right vertebral artery was 20.9 mm. The left vertebral artery originated from the left subclavian artery in 484 of 514 arteries and the mean distance between the origin of the left subclavian artery and the left vertebral artery was 32.1 mm. The remaining 30 arteries (5.8%) originated from the aortic arch between the left common carotid artery and the left subclavian artery and this frequency is similar to previously published data. There was no right-left difference for the entrance point of the vertebral arteries into the cervical transverse foramen and the 6th cervical vertebra (C6) was the most common entrance point. Seventy-eight percent of our cases had right and left vertebral arteries that originated in the subclavian arteries and entered the cervical transverse foramen at C6. Among the 30 left vertebral arteries that originated from the aortic arch, 20 arteries (66.7%) entered a cervical transverse foramen at a level higher than C6. This frequency was higher than that for the left vertebral artery that originated from the subclavian artery.     

椎动脉椎前部的形态特点及临床意义

目的 :探讨影响椎动脉椎前部供血的解剖学基础。方法 :5 1例成人尸体标本 ,解剖观察椎动脉椎前部的主要毗邻结构 ,测量椎动脉椎前部两端管腔外径、长度及其与锁骨下动脉形成的角度。结果 :①椎动脉椎前部可分为正常型和先天异常型 ,其中正常型左侧椎动脉外径大于右侧 ,左侧椎动脉与同侧锁骨下动脉形成角度小于右侧 ,两者均具有统计学的显著性差异 (P <0 .0 5 ) ,但左右两侧椎动脉椎前部长度无显著性差异。②椎动脉椎前部前方有胸锁乳突肌 ;后方有第 7颈椎横突、颈交感干等结构 ,其中颈中、下神经节发出分支形成椎动脉丛并支配该动脉 ,后内侧邻接胸膜顶、颈长肌、头长肌、外侧为前斜角肌。结论 :正常成人左侧椎动脉椎前部较右侧为优势供血动脉 ,但是血管本身或毗邻结构改变有时可致椎动脉管腔狭窄 ,发生供血不足     

Coincidence of a right retroaortic circumflex coronary artery and a right-sided aortic arch with a retroesophageal course of the left subclavian artery (arteria lusoria)

An anomalous branch of the right coronary artery was found in a 71-year-old male cadaver with a right-sided aortic arch. The anomalous artery arose from the proximal portion of the right coronary artery and ran in a retroaortic course, before reaching the posterior wall of the heart. It was recognized as the right-sided variation of the circumflex coronary artery. The aortic arch had as branches the left common carotid, right common carotid, right subclavian, and left subclavian arteries, in that order, and the descending aorta was located in the right thorax. The left subclavian artery arose from a Kommerell's diverticulum and ran behind the esophagus, and the left-sided ligamentum arteriosum was also connected at the diverticulum. Therefore, the right aortic arch was classified as type N according to Adachi-Williams-Nakagawa and type III-B1 in accordance with Stewart-Edwards. The Kommerell's diverticulum in this case seemed to press on the posterior wall of the esophagus.     

Gross morphology of the bridges over the vertebral artery groove on the atlas

The bony bridges of the atlas over the groove of the vertebral artery are commonly seen in plain radiographs of the cervical spine, and it is a subject of controversy whether they cause compression of the underneath lying vertebral artery. To clarify this we examined a total of 176 dried and complete atlas vertebrae and found the presence of a canal for the vertebral artery (CVA) in 10.23% and an incomplete canal for the vertebral artery in 24.43%. The CVA and incomplete CVA is more common in males (11.11% and 24.9%) than in females (9.3% and 24.42%). We found a higher incidence of CVA in laborers (37.5%) than in nonlaborers (4.16%). The incomplete CVA appeared to be more characteristic in the age group of 5–44 years. In the age group of 45–90 years the CVA was characteristic, which probably means that an incomplete CVA is the precursor of a CVA. The superoinferior diameter of the CVA canal ranged from 5.1 to 6.1 mm at the right side and from 4.6 to 5.8 mm at the left side, while the anteroposterior diameter was 5.6–6.9 mm at the right side and 6.1–7.2 mm at the left side. We also found a high incidence of coexistence of CVA and the retrotransverse foramen (72.22%) which means that because of possible compression of the vertebral veins the blood flow is directed into the small vein of the retrotransverse foramen. Finally, in 93.5% of unilateral CVA a deeply excavated contralateral groove of the vertebral artery was found.     

肺移植中支气管动脉的应用解剖

目的：提供肺移植支气管动脉吻合术有关的参考资料。方法：于肺根处逆向解剖了２２具成人尸体的支气管动脉，观察其外径和行程规律。结果：左支气管动脉起于主动脉弓下缘→左支气管上缘，和／或起于胸主动脉前壁→左支气管下缘，外径均为１．７ｍｍ。右支气管动脉主要起于右侧肋间动脉→右支气管后壁，外径２．０ｍｍ，是右肺、支气管的主要营养动脉；其次起于主动脉弓下缘、胸主动脉前壁→右支气管下缘，也可以是合干支气管动脉（出现率约１／３）的右支。结论：支气管动脉与胸廓内动脉吻合是肺移植血供重建的术式，但对于“后壁”右支气管动脉，宜将其肋间后动脉主干与受体的相应动脉吻合     

颅外椎动脉侧支吻合的观察及其临床意义

目的：观察椎动脉颅外段的仙支吻合情况,并探讨其临床意义,方法：17具防腐尸体标本并结合5具头颈部血管铸型标本,观察椎动脉与颈 脉,锁骨下动脉分支之间的血管吻合,结果：椎动脉与颈动脉的分支颈升动脉,咽升动脉以及颈深动脉等有广泛的吻合,一般为细小的肌支吻合,椎动脉与枕动脉间的血管吻合比较恒定,有两种类型：直接吻合（10％）和肌支吻合（占90％）。结论：颅外椎动脉侧支吻合是椎动脉代偿机制的重要解剖学基础之一,在椎基底动脉供血不足发病中有重要的意义。     

Spontaneous dissecting aneurysm of the intracranial vertebral artery: management strategies

PURPOSE: Pathogenesis and treatment of spontaneous dissecting aneurysm of the intracranial vertebral artery (VA) remain controversial. This study was designed to provide management strategies and to improve management outcome in patients with these aneurysms. MATERIALS AND METHODS: Among a total of 1,990 patients treated for intracranial aneurysms from February 1992 to June 2005, 28 patients (1.4%) were treated either by surgery (8 patients) or neurointervention (20 patients) for spontaneous dissecting aneurysms of the intracranial VA. Twenty-two patients had ruptured aneurysms. We analyzed indications of surgery or neurointervention for each case, and assessed the management outcome at a 6-month follow-up. RESULTS: For selection of therapeutic options, patients were initially evaluated as possible candidates for neurointervention using the following criteria: 1) poor clinical grade; 2) advanced age; 3) medical illness; 4) unruptured aneurysm; 5) equal or larger opposite VA; 6) anticipated surgical difficulty due to a deep location of the VA-posterior inferior cerebellar artery (PICA) junction. Surgery was considered for patients with: 1) high-risk aneurysms (large or irregular shaped); 2) smaller opposite VA; 3) failed neurointervention; or 4) dissection involving the PICA. Management outcomes were favorable in 25 patients (89.3%). Causes of unfavorable outcome in the remaining 3 patients were the initial insult in 2 patients, and medical complications in one patient. CONCLUSION: Ruptured aneurysms must be treated to prevent rebleeding. For unruptured aneurysms, follow-up angiography would be necessary to detect growth of the aneurysm. Treatment modality should be selected according to the clinical characteristics of each patient and close collaboration between neurosurgeons and neurointerventionists is essential.     

Anomalous origin and cervical course of the vertebral artery in the presence of a retroesophageal right subclavian artery

The vertebral artery is usually described as the first branch of the subclavian artery, originating medial to the scalenus anterior muscle. During its cervical course, the vertebral artery presents a prevertebral segment and then enters the foramen transversarium of the sixth cervical vertebra. We describe a case of an unusual origin and course of the right vertebral artery in a cadaver specimen wherein the right vertebral artery originates from the right common carotid artery at the inferior border of the thyroid gland. In its cervical course the vertebral artery ascends outside and anteriorly to the foramen transversarium of vertebrae C VI to C III, and enters the foramen transversarium of the axis. In the same specimen, a retroesophageal right subclavian artery is also present. These vascular abnormalities are presented for physicians to keep in mind such variations during diagnostic investigation and surgical procedures of the neck.     

极外侧经髁人路识别和保护椎动脉的显微解剖学研究

目的 为极外侧经髁入路术中识别和保护椎动脉提供翔实的显微解剖学资料。方法 模拟极外侧经髁入路对10例成人尸头标本进行显微解剖．对椎动脉进行观察、测量和拍照。尤其关注椎动脉识别和保护的方法。结果 肩胛提肌和头下斜肌、头外侧直肌、C2神经前支、寰椎横突、寰推后结节和椎动脉周围静脉丛是识别椎动脉的解剖标志；椎动脉行程曲折，易受损伤，术中应妥善保护。结论 观察、测量的结果有助于术中椎动脉的识别和保护。     

CT增强扫描图像椎动脉和颈内动脉的三维重建研究

目的:探讨CT增强扫描图像在椎动脉、颈内动脉3D可视化技术中的应用。方法:1例经CT增强连续扫描检查的成人患者数据集,应用Mimics8.11对图像血管进行分割,三维重建椎动脉、颈内动脉颅内段数字图像。结果:椎动脉、颈内动脉颅内段三维重建数字图像清晰,能够准确的3D显示该血管解剖形态结构及其在颈椎、颅骨内的位置和毗邻关系。结论:三维重建图像可以提供复杂血管动态解剖,为临床诊断提供了直观的、数字化解剖参考。     

超声e—Flow技术在椎动脉检查中的价值

目的对比超声彩色多普勒血流显像（CDFI）与e—Flow技术在椎动脉（VA）检查中的作用。方法选择高频超声血流显示较为困难的健康体检者24例,其中男性14例,女性10例,年龄22～58岁（平均年龄44岁）,对于同一个受试者分别使用彩色多普勒血流显像及e—Flow技术了解椎动脉血流的显示情况,并使用Photoshop图像软件进行有效像素分析。结果CDFI和e—Flow组血管像素占总像素的比例分别4．2‰±2．2‰、7．1‰±2．9‰,两组比较差异具有统计学意义（P〈0．05）。结论e—Flow技术对于常规检查较为困难的人群,血流显示效果优于CDFI。     

双椎动脉变异的影像学特点及临床意义-附3例报道

报道经血管造影证实的3例双椎动脉变异病例:2例为颅外段的椎动脉开窗畸形,其中1例伴有大脑中动脉分叉处动脉瘤,1例左椎动脉起于主动脉弓的变异;另1例为右侧椎动脉双起源变异,伴旁路血管内血栓形成。结合文献对这一现象的胚胎成因及临床意义进行了讨论。