Successful Angioplasty of Left Vertebral Artery and Right Subclavian Artery Via Retrograde Approach

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.

Download Full-text

Non-Standard Management of Target Vessels With the Inner Branch Arch Endograft: A Single-Center Retrospective Study

Journal of Endovascular Therapy ◽

10.1177/15266028211058682 ◽

2021 ◽

pp. 152660282110586

Author(s):

Jose I. Torrealba ◽

Konstantinos Spanos ◽

Giuseppe Panuccio ◽

Fiona Rohlffs ◽

Thomas Gandet ◽

...

Keyword(s):

Retrospective Study ◽

Vertebral Artery ◽

Subclavian Artery ◽

False Lumen ◽

Aberrant Right Subclavian Artery ◽

Left Vertebral Artery ◽

Type I ◽

Single Center ◽

Standard Management

Purpose: The purpose of this study was to evaluate early and mid-term results of non-standard management of the supraaortic target vessels with the use of the inner branch arch endograft in a single high-volume center. Material and methods: A single-center retrospective study including all patients undergoing implantation of an inner branch arch endograft from December 2012 to March 2021, who presented a non-standard management of the supraaortic target vessels (any bypass other than a left carotid-subclavian or landing in a dissected target vessel). Technical success, mortality, reinterventions, endoleak (EL), and aortic remodeling at follow-up were analyzed. Results: Twenty-four patients were included. In 17 (71%) cases, the non-standard management was related to innominate artery (IA) compromise (12 with IA dissection, 2 with short IA, 2 with short proximal aortic landing zone that required occlusion of IA, 1 with occluded IA after open arch repair). Two (8%) cases were related to an aberrant right subclavian artery (RSA), 1 patient (4%) due to the concomitant presence of a left vertebral artery (LVA) arising from the arch and an occluded left subclavian artery (LSA), and another patient presented with an occluded LSA distal to a dominant vertebral artery. Three (13%) cases were exclusively related to management in patients with genetic aortic syndromes. Twenty (83%) patients had a previous type A aortic dissection. Ten (42%) patients presented a thoracic or thoracoabdominal aortic aneurysm and 8 (33%) patients an arch aneurysm, 6 of them associated to false lumen (FL) perfusion. There were 2 (8%) perioperative minor strokes, and 1 patient with perioperative mortality. Seven patients presented an early type I endoleak, all resolved at follow-up. Seven patients required reinterventions during follow-up (7 reinterventions related to continuous false lumen perfusion, 3 related to Type Ia endoleak, 2 related to surgical bypass). All patients who presented with FL perfusion had complete FL thrombosis at follow-up. No patient presented aneurysm growth at follow-up. Conclusions: The use of the inner branch arch endograft with a non-standard management of the supraaortic target vessels is a possible option. Despite a high reintervention rate, regression or stability of the aneurysmal diameter was achieved in all the patients with follow-up.

Download Full-text

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.

Download Full-text

A Five-Vessel Aortic Arch with an Anomalous Origin of Both Vertebral Arteries and an Aberrant Right Subclavian Artery

Interventional Neuroradiology ◽

10.1177/159101990401000404 ◽

2004 ◽

Vol 10 (4) ◽

pp. 309-314 ◽

Cited By ~ 9

Author(s):

P.A. Brouwer ◽

M.P.S. Souza ◽

R. Agid ◽

K.G. terBrugge

Keyword(s):

Carotid Artery ◽

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Anomalous Origin ◽

Aberrant Right Subclavian Artery ◽

Left Vertebral Artery ◽

Transverse Foramen ◽

The Right

In this case presentation we describe a patient with an anomalous origin of the right vertebral artery arising from the right common carotid artery in combination with an aberrant right subclavian artery and a left vertebral artery originating from the arch between the left common carotid artery and left subclavian artery. Hence there were five vessels originating from the aortic arch. The possible embryological mechanism as well as a postulation on the importance of the level of entrance of the vertebral artery in the cervical transverse foramen is discussed.

Download Full-text

Ruptured vertebrobasilar junction aneurysm unmasking subclavian steal syndrome

Surgical Neurology International ◽

10.25259/sni_561_2020 ◽

2020 ◽

Vol 11 ◽

pp. 419

Author(s):

Vivek Murumkar ◽

Shumyla Jabeen ◽

Sameer Peer ◽

Aravinda Hanumanthapura Ramalingaiah ◽

Jitender Saini

Keyword(s):

Vertebral Artery ◽

Subclavian Artery ◽

Subclavian Steal Syndrome ◽

Left Vertebral Artery ◽

Vertebrobasilar Insufficiency ◽

Subclavian Steal ◽

Subclavian Artery Occlusion ◽

Retrograde Filling ◽

Vertebrobasilar Junction ◽

Steal Syndrome

Background: Subclavian steal occurs due to stenosis or occlusion of the subclavian artery or innominate artery proximal to the origin of the vertebral artery. Often asymptomatic, the condition may be unmasked due to symptoms of vertebrobasilar insufficiency triggered by strenuous physical exercise involving the affected upper limb. The association of vertebrobasilar junction (VBJ) aneurysms with subclavian steal syndrome has been rarely reported. Hereby, we present a case of VBJ aneurysm associated with subclavian steal treated successfully with endovascular coiling. Case Description: A 65-year-old female presented in the emergency department with acute severe headache and vomiting with no focal neurological deficits. Non-contrast computed tomography of the brain showed modified Fischer Grade 3 subarachnoid hemorrhage. Subsequent digital subtraction angiogram (DSA) showed VBJ aneurysm directed inferiorly with the left subclavian artery occlusion. There was retrograde filling of the left vertebral artery on right vertebral injection, confirming the diagnosis of subclavian steal. Balloon assisted coiling of the VBJ aneurysm was performed while gaining access through the stenotic left vertebral artery ostium which provided a more favorable hemodynamic stability to the coil mass. Conclusion: Subclavian steal exerting undue hemodynamic stress on vertebrobasilar circulation can be an etiological factor for the development of the flow-related aneurysms. Access to the VBJ aneurysms may be feasible through the stenosed vertebral artery if angioplasty is performed before the coiling of the aneurysm.

Download Full-text

Morphological characteristics of the aortic arch organization

ARS Medica Tomitana ◽

10.2478/arsm-2013-0012 ◽

2013 ◽

Vol 19 (2) ◽

pp. 67-73 ◽

Cited By ~ 1

Author(s):

A.M. Manole ◽

D.M. Iliescu ◽

R. Baz ◽

P. Bordei

Keyword(s):

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Left Vertebral Artery ◽

Morphological Aspect ◽

Arterial Trunk ◽

Brachiocephalic Trunk ◽

The Right ◽

Number Of Branches

Abstract Our study was performed on 228 cases by dissection, by plastic injection followed by corrosion or dissection and by simple and CT angiography study. Each morphological aspect was assessed on a different numbers of cases, as long as the same case could not provide data on all studied elements. We assessed: the number of branches that originate from the aortic arch, the level of origin and the morphological type of the aortic arch. In terms of number of branches emerging from the aortic arch, most commonly are three branches, in 48.48% of cases, describing them 3 variations: separation of the three classical branches in 45,96% of cases, in 1.51% of cases the left common carotid artery emerged from the brachiocephalic trunk while the other two branches being represented by a vertebral artery and the left subclavian and in 1.01% by the right subclavian artery with retroesophageal traject, by a bicarotid arterial trunk and the left subclavian artery. In 28.70% of the cases were four branches, as follows: in 13.13% of cases the fourth branch was represented by the left vertebral artery, in 7.07% of cases there was the inferior thyroid artery, in 4.04% of cases the brachiocephalic arterial trunk was missing and the right subclavian artery originate from the aortic arch and presented a retroesophageal traject, in 3.03% of cases the fourth artery was the ascending cervical and in 1.51% of cases all four arteries had their origins in the aortic arch with no brachiocephalic trunk. In 22.73% of cases from the aortic arch originated only two branches: in 19.70% of cases the left common carotid originated in the brachiocephalic trunk, so the second branch was the left subclavian and in 3.03% of the cases there were two brachiocephalic trunks. Regarding the level of origin from the aortic arch, we found that only the brachiocephalic arterial trunk showed versions of origin: in 64 61% of the cases the brachiocephalic trunk had its origin in the horizontal segment of the aortic arch, in 21.54% of cases the origin was located at the limit between the ascending and horizontal segments and vin 12.31% of cases the origin was from the ascending segment of the aortic arch. In only 1.54% of the cases the left subclavian artery originated from the descending segment of the aortic arch

Download Full-text

Terminal Triplication of the Left Vertebral Artery: A Unique Variation

Interventional Neuroradiology ◽

10.1177/159101990701300413 ◽

2007 ◽

Vol 13 (4) ◽

pp. 399-401

Author(s):

P.H. Dissanayake ◽

J.J. Bhattacharya ◽

E.V. Teasdale

Keyword(s):

Vertebral Artery ◽

Ct Angiography ◽

Subclavian Artery ◽

Basilar Artery ◽

Clinical Importance ◽

Aberrant Right Subclavian Artery ◽

Left Vertebral Artery ◽

Unique Case ◽

The Right ◽

Unique Variation

This report describes a unique case of triplication of the terminal left vertebral artery, forming the basilar artery in a 75-year-old male. CT angiography of cranio-cervical vessels also demonstrated the right vertebral artery originating from the right common carotid and an aberrant right subclavian artery. To the best of our knowledge this is the first report of a variation of this nature. The embryology and the clinical importance are discussed.

Download Full-text

Fourth branch of arch of aorta and its clinical implication

Journal of Biomedical Sciences ◽

10.3126/jbs.v2i3.14765 ◽

2016 ◽

Vol 2 (3) ◽

pp. 24-27

Author(s):

Rashmi N Gitte ◽

Chenna Reddy Ganji ◽

Vishal M Salve

Keyword(s):

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Left Vertebral Artery ◽

Branching Pattern ◽

Human Beings ◽

Vertebral Arteries ◽

Brachiocephalic Trunk ◽

Great Vessels ◽

The Right

In human beings the most common branching pattern of the aortic arch was its division into three great vessels ie the brachiocephalic trunk, left common carotid artery and the subclavian artery. The vertebral arteries arise from the superior aspect of the first part of the subclavian artery. In present case, a left vertebral artery arose from the aortic arch as fourth branch was found. The diameter of left vertebral artery at its origin was 6 mm as compared to the right vertebral artery, which has diameter of 3.5 mm at its origin. In this case left sixth dorsal intersegmental artery might have persisted as first part of vertebral artery hence left vertebral artery arising from arch of aorta. Knowledge of the variations in branching pattern of the aortic arch is important in the diagnosis of intracranial aneurysm after subarachnoid haemorrhage.J. Biomed. Sci. 2015, 2(3):21-23.

Download Full-text

Retroesophageal right subclavian artery associated with a bicarotid trunk and an ectopic origin of vertebral arteries

Surgical and Radiologic Anatomy ◽

10.1007/s00276-021-02746-1 ◽

2021 ◽

Author(s):

Barbara Buffoli ◽

Vincenzo Verzeletti ◽

Lena Hirtler ◽

Rita Rezzani ◽

Luigi Fabrizio Rodella

Keyword(s):

Carotid Artery ◽

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Distal Part ◽

Aberrant Right Subclavian Artery ◽

Left Vertebral Artery ◽

Vertebral Arteries ◽

The Right

AbstractA rare branching pattern of the aortic arch in a female cadaver is reported. An aberrant right subclavian artery originated from the distal part of the aortic arch and following a retroesophageal course was recognized. Next to it, from the left to the right, the left subclavian artery and a short bicarotid trunk originating the left and the right common carotid artery were recognized. An unusual origin of the vertebral arteries was also identified. The left vertebral artery originated directly from the aortic arch, whereas the right vertebral artery originated directly from the right common carotid artery. Retroesophageal right subclavian artery associated with a bicarotid trunk and ectopic origin of vertebral arteries represents an exceptional and noteworthy case.

Download Full-text

Carotid-Vertebral or Carotid-Subclavian Transpositions in Supra-Aortic Steno-Occlusive Diseases When Endovascular Therapy Is Unfeasible or Unsuccessful

International Surgery ◽

10.9738/intsurg-d-17-00097.1 ◽

2021 ◽

Vol 105 (1-3) ◽

pp. 455-463

Author(s):

Jian Wang ◽

Jie Chu ◽

Lihua Zhang ◽

Juan Chen ◽

Yi Zheng ◽

...

Keyword(s):

Carotid Artery ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Subclavian Artery ◽

Endovascular Intervention ◽

Treatment Modalities ◽

Left Vertebral Artery ◽

Severe Stenosis ◽

Brachiocephalic Trunk ◽

The Right

Background and purpose Despite advances in endovascular therapies, some patients experience vertebral artery stenosis or subclavian artery occlusion and may not benefit from less-invasive angioplasty/stenting. This study described 4 cases in which carotid-vertebral transposition (CVT) or carotid-subclavian transposition (CST) was adapted when endovascular treatment was unfeasible or unsuccessful. Presentation Case 1: A 65-year-old woman presented with severe stenosis of the right vertebral artery ostium, dysplastic left vertebral artery, and aneurysmal dilatation of proximal right subclavian artery and brachiocephalic trunk. Case 2: A 23-year-woman had severe stenosis at the first portion of left vertebral artery caused by Takayasu's arteritis. Because endovascular intervention was unfeasible, CVTs were performed in cases 1 and 2. Case 3: A 73-year-old man presented with total occlusion of the proximal right subclavian artery and severe stenosis of the right internal carotid artery. Case 4: A 58-year-old man experienced complete occlusion of the left subclavian artery and severe stenosis of the left common carotid artery. Duplex ultrasonography showed reverse flow in the vertebral artery in keeping with vertebral steal syndrome. Endovascular treatment was unsuccessful because the wire did not cross the occlusion of the subclavian artery. CSTs were performed with concurrent ipsilateral carotid endarterectomy in cases 3 and 4. Conclusion The present case series demonstrated that CST and CVT were effective treatment modalities for subclavian or vertebral artery lesions. Although endovascular stenting and angioplasty have been advocated as first-line management, CST and CVT should be considered as the remedy when endovascular intervention is unsuccessful or unfeasible.

Download Full-text