Aberrant Right Vertebral Artery Originating From the Descending Thoracic Aorta, With Simultaneous Left Vertebral Artery Takeoff From the Aortic Arch

Aim. Assessment of normal and variant aortic arch anatomy in patients with type A aortic dissection and aneurysm of the arch and descending thoracic aorta.Methods. We retrospectively studied computer tomography (CT) data of chest organs with contrast in patients who underwent reconstruction of the aortic arch in type I aortic dissection according to DeBakey classification (n = 61) and resection of the aortic arch and descending thoracic aorta aneurysm (n = 14) at the Meshalkin National Medical Research Center, Novosibirsk, Russian Federation. The control group included patients without aortic arch pathology (n = 52). To identify relationships between the anatomical type of aortic arch and the risk of aortic pathology development, univariate and multivariate binary logistic regression analyses were used.Results. Our analysis revealed four types of aortic arch anatomy. Normal aortic arch anatomy occurred in 66.1 % of patients (n = 84), the proportion of abnormalities of the left common carotid artery was 30 % (bovine aortic arch occurred in 15 %, and the same site of origin of left common carotid artery and brachiocephalic trunk occurred in 15 %). Divergence of the left vertebral artery from the aortic arch between the left common carotid and left subclavian arteries occurred in 3.1 % (n = 4), and the combination of “bovine trunk” and divergence of the left vertebral artery from the aortic arch was detected in 0.8 % patients (n = 1). Logistic regression analyses revealed no statistically significant relationships between variant aortic arch anatomy and the development of type A aortic dissections and aortic arch aneurysms. The presence of the common origin of brachiocephalic trunk and left common carotid artery was associated with a reduced risk of acute aortic dissection type I by 89 %, or an OR of 0.11 (95% CI: 0.03–0.46) (p = 0.002).Conclusion. Our data will help with future planning surgical interventions on the aortic arch and descending thoracic aorta.Received 17 June 2020. Revised 16 July 2020. Accepted 17 July 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and design: A.A. Shadanov Data collection and analysis: A.A. Shadanov, T.A. Bergen Statistical analysis: D.A. Sirota, A.A. Shadanov Drafting the article: A.A. Shadanov Critical revision of the article: D.A. Sirota, M.M. Lyashenko, A.M. Chernyavskiy Final approval of the version to be published: A.A. Shadanov, D.A. Sirota, T.A. Bergen, M.M. Lyashenko, A.M. Chernyavskiy

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Emergent left upper extremity revascularization following stent-grafting of the descending thoracic aorta in a patient with an aberrant left vertebral artery

Hellenic Journal of Surgery ◽

10.1007/s13126-014-0106-0 ◽

2014 ◽

Vol 86 (2) ◽

pp. 102-105

Author(s):

D. Tassopoulos ◽

B. Anagnostakou ◽

Th. Kratimenos ◽

D. Exarchos ◽

A. Lioulias ◽

...

Keyword(s):

Vertebral Artery ◽

Upper Extremity ◽

Thoracic Aorta ◽

Left Vertebral Artery ◽

Descending Thoracic Aorta ◽

Stent Grafting

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Anatomical Variations in the Branching Pattern of Human Aortic Arch: A Cadaveric Study from Central India

ISRN Anatomy ◽

10.5402/2013/828969 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Virendra Budhiraja ◽

Rakhi Rastogi ◽

Vaishali Jain ◽

Vishal Bankwar ◽

Shiv Raghuwanshi

Keyword(s):

Carotid Artery ◽

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Left Vertebral Artery ◽

Common Trunk ◽

Branching Pattern ◽

Brachiocephalic Trunk

Variations of the branches of aortic arch are due to alteration in the development of certain branchial arch arteries during embryonic period. Knowledge of these variations is important during aortic instrumentation, thoracic, and neck surgeries. In the present study we observed these variations in fifty-two cadavers from Indian populations. In thirty-three (63.5%) cadavers, the aortic arch showed classical branching pattern which includes brachiocephalic trunk, left common carotid artery, and left subclavian artery. In nineteen (36.5%) cadavers it showed variations in the branching pattern, which include the two branches, namely, left subclavian artery and a common trunk in 19.2% cases, four branches, namely, brachiocephalic trunk, left common carotid artery, left vertebral artery, and left subclavian artery in 15.3% cases, and the three branches, namely, common trunk, left vertebral artery, and left subclavian artery in 1.9% cases.

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Left vertebral artery arising directly from the aortic arch

Sri Lanka Anatomy Journal ◽

10.4038/slaj.v1i2.41 ◽

2017 ◽

Vol 1 (2) ◽

pp. 52

Author(s):

H. A. Amaratunga ◽

S. P. M. Peiris ◽

H. R. Gunasena ◽

J. K. Dissanayake

Keyword(s):

Vertebral Artery ◽

Aortic Arch ◽

Left Vertebral Artery

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Treating the patient with acute rupture of penetrating atherosclerotic ulcer of the thoracic aorta

Kazan medical journal ◽

10.17750/kmj2015-377 ◽

2015 ◽

Vol 96 (3) ◽

pp. 377-380

Author(s):

I R Yagafarov ◽

R R Sayfullin ◽

M M Iskhakov ◽

N V Gazizov ◽

M G Khatypov ◽

...

Keyword(s):

Aortic Arch ◽

Thoracic Aorta ◽

Spontaneous Rupture ◽

Open Surgery ◽

Intraoperative Complications ◽

Long Term Results ◽

Safe Procedure ◽

Descending Thoracic Aorta ◽

Prosthetic Repair ◽

Penetrating Atherosclerotic Ulcer

Spontaneous rupture of the aorta - a violation of the integrity of the aortic wall which is not caused by an aneurysm, trauma, dissection or disintegrating tumor process, and is an acute life-threatening condition. According to some authors, the main cause of spontaneous rupture of the aorta is a penetrating atherosclerotic ulcer of the aorta, which is an ulceration of aortic atherosclerotic plaque leading to penetration of the internal elastic plate in media. We present a case of successful hybrid surgical treatment of patient with spontaneous rupture of the descending thoracic aorta with the formation of para-aortic hematoma and left-sided hemothorax. The patient underwent a hybrid operation - aortic arch and descending thoracic aorta prosthetic repair, subclavian bypass with left subclavian artery ligation, left-sided thoracotomy, and pleural cavity sanitation. No intraoperative complications were observed, the patient was taken off the ventilator on day 2. The control computed tomography performed on day 10, revealed correct and stable stent graft position with no signs of continued bleeding, endoleak. The patient was discharged in satisfactory condition on day 14. Due to the high hospital mortality of open surgery on the thoracic aorta in case of penetrating atherosclerotic ulcers, as well as the predominance of elderly patients with severe comorbidities that contraindicate open surgery using cardiopulmonary bypass, endovascular and hybrid technologies, which are minimally invasive and traumatic, come to the fore. Endovascular prosthetic repair in case of penetrating atherosclerotic ulcer of aortic arch and descending thoracic aorta is an effective and safe procedure in patients at high risk, showing encouraging long-term results.

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Intraoperative video showing the sequence of the operation highlighting the removal of the stent and infected material and further reconstruction of the aortic arch, proximal descending thoracic aorta and supra-aortic trunks using a Thoraflex PlexusTM (Terumo Aortic, Vascutek) with cardiopulmonary bypass, moderate hypothermic circulatory arrest and antegrade cerebral perfusion.

ASVIDE ◽

10.21037/asvide.2021.367 ◽

2021 ◽

Vol 8 ◽

pp. 367-367

Author(s):

Ana Lopez-Marco ◽

Saleem Jahangeer ◽

Benjamin Adams ◽

Aung Ye Oo

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Arch ◽

Thoracic Aorta ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Descending Thoracic Aorta ◽

Infected Material ◽

Antegrade Cerebral Perfusion

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Anomalous Origin of the Vertebral Artery

Journal of Morphological Sciences ◽

10.1055/s-0038-1676779 ◽

2018 ◽

Vol 35 (04) ◽

pp. 216-217

Author(s):

André Shinohara ◽

Beatriz Sangalette ◽

Mateus Silva ◽

Laís Rinaldi ◽

Juliane Souza ◽

...

Keyword(s):

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Surgical Procedures ◽

Foramen Magnum ◽

Left Vertebral Artery ◽

Clear Understanding ◽

Case Presentation ◽

Human Specimen ◽

The Common

Introduction The present article presents a rare case of variation of the left vertebral artery, which originated from the aortic arch, between the common carotid artery and the subclavian artery, although classic descriptions of the vertebral artery indicate its origin at the subclavian artery, where it penetrates the foramen transverse and ascends cervically to the foramen magnum. Case presentation The anatomical peculiarity of the vertebral artery is evidenced. The origin of the vertebral artery was identified directly from the aortic arch in a dissected human specimen. Conclusion In view of the numerous surgical procedures performed in this area, the clear understanding of its topographic layout is indispensable, and might change surgical procedures performed in the region.

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