Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492006000200004
Jornal Vascular Brasileiro
Original Article

Anatomical organization of aortic arch variations in the India: embryological basis and review

Organização anatômica das variações do arco aórtico na população indiana: base e revisão embriológica

Soubhagya R. Nayak; Mangala M. Pai; Latha V. Prabhu; Sujatha D'Costa; Prakash Shetty

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Abstract

OBJECTIVES: To determine the percentage and type of aortic arch variations in Indian subjects and their clinical and surgical importance and embryological basis. PATIENTS AND METHOD: In our investigation, branching patterns of the aortic arch were studied in 62 formalin-fixed cadavers of both sexes of Indian origin, aged 45-79. The dissections were carried out in formalin-preserved cadavers and the aortic arch variations were observed after exposing the thoracic and cervical region during routine dissection of undergraduate students of Indian origin in Kasturba Medical College, Mangalore. RESULTS: The usual three-branched aortic arch was found in 56 cadavers (91.4%); variations were found in six cadavers (9.6%); 4.8% presented common origin of the carotid arteries; 1.6% had bi-innominate sequence, and the same specimen had left coronary artery arising from arch of aorta directly; 1.6% presented right subclavian artery arising directly from the aorta; 1.6% had left vertebral artery a branch of aortic arch. Five out of six cadavers with anomalous aortic arch branching pattern were females. One male cadaver presented anomalous origin of left vertebral artery directly from the arch. CONCLUSION: The wide spectrum of variations in the anatomical arrangements of the aortic arch branches in the Indian population was at par with other populations of the world. Although anomalous origins of the aortic arch branches are merely anatomic variants, accurate information about them is vital for vascular surgery in the thorax, head and neck region.

Keywords

Aortic arch, vertebral artery, brachiocephalic trunk, variations

Resumo

OBJETIVOS: Determinar a porcentagem e o tipo de variações do arco aórtico em indivíduos indianos, bem como sua importância clínica e cirúrgica e base embriológica. PACIENTES E MÉTODOS: Em nossa investigação, os padrões de ramificação do arco aórtico foram estudados em 62 cadáveres fixados em formalina de ambos os sexos, de origem indiana e com idade entre 45 e 79 anos. As dissecações foram realizadas em cadáveres preservados em formalina, e as variações do arco aórtico foram observadas após a exposição das regiões torácica e cervical durante a dissecação de rotina de alunos da graduação do Kasturba Medical College, Mangalore, Índia. RESULTADOS: O arco aórtico normal de três ramificações foi encontrado em 56 cadáveres (91,4%); as variações foram encontradas em seis cadáveres (9,6%); 4,8% apresentavam origem comum das artérias carótidas; 1,6% tinham seqüência binominada, e o mesmo espécime tinha a origem da artéria coronária esquerda diretamente no arco aórtico; 1,6% apresentavam a origem da artéria subclávia direita diretamente na aorta; 1,6% tinham como ramificação do arco aórtico uma artéria vertebral esquerda. Cinco de seis cadáveres com padrão de ramificação anômalo do arco aórtico eram do sexo feminino. Um cadáver do sexo masculino apresentou origem anômala da artéria vertebral esquerda diretamente no arco. CONCLUSÃO: O amplo espectro de variações nos padrões anatômicos das ramificações do arco aórtico na população indiana estava em concordância com outras populações mundiais. Embora as origens anômalas das ramificações do arco aórtico sejam meramente variações anatômicas, informações precisas sobre elas é essencial para a cirurgia vascular na região do tórax, cabeça e pescoço.

Palavras-chave

Arco aórtico, artéria vertebral, tronco braquiocefálico, variações

References

Barry A. The aortic arch derivatives in the human adult. Anat Rec.. 1951;111(2):221-38.

Barwell . Abnormal origin of arteries from the aortic arch. Trans Pathol Soc Lond.. 1867;18.

Birmingham A. Extreme anomaly of the heart and great vessels. J Anat Physiol.. 1893;27:139-50.

Brodie G. Rare abnormality of the aortic arch. Lancet. 1888;2.

Brown JD, Brown FJ. Abnormal origin of the vessels from the arch of the aorta. Brit Med J.. 1868;1.

De Garis CF, Black IH, Riemenschneider EA. Patterns of the aortic arch in American white and Negro stocks, with comparative notes on certain other mammals. J Anat.. 1933;67:599-619.

Harley HR. The development and anomalies of the aortic arch and its branches. Br J Surg.. 1959;46:561-73.

Lize I. Abnormal origin of the great blood vessels from the aortic arch. Folia Morphol (Warsaw). 1970;29:355-7.

Grande NR, Costa e Silva A, Pereira AS, Aguas AP. Variations in the anatomical organization of the human aortic arch: A study in a Portuguese population. Bull Assoc Anat (Nancy). 1995;79(244):19-22.

Bhatia K, Ghabriel MN, Henneberg M. Anatomical variations in the branches the human aortic arch: a recent study of a South Australian population. Folia Morphol (Warsz). 2005;64(3):217-23.

Bernardi L, Deton P. Angiographic study of a rare anomalous origin of the vertebral artery. Neuroradiology. 1975;9:43-7.

Flynn RE. External carotid origin of the dominant vertebral artery: Case report. J Neurosurg. 1968;29:300-1.

Lemke AJ, Benndorf G, Liebig T, Felix R. Anomalous origin of the right vertebral artery: review of the literature and case report of right vertebral artery origin distal to the left subclavian artery. AJNR Am J Neuroradiol. 1999;20:1318-21.

Fazan VPS, Ribeiro RA, Ribeiro JAS, Rodrigues Filho OA. Right retroesophageal subclavian artery. Acta Cir Bras.. 2003;18:54-6.

Momma K, Matsuoka R, Takao A. Aortic arch anomalies associated with chromosome 22q11 deletion (CATCH 22). Pediatr Cardiol.. 1999;20:97-102.

Satyapal KS, Singaram S, Partab P, Kalideen JM, Robbs JV. Aortic arch branch variations: case report and arteriographic analysis. S Afr J Surg.. 2003;41:48-50.

Moskowitz WB, Topaz O. The implications of common brachiocephalic trunk on associated congenital cardiovascular defects and their management. Cardiol Young. 2003;13:537-43.

Anson BV, Mcvay CB. Surgical anatomy. 1971.

Matula C, Trattnig S, Tschabitscher M, Day JD, Koos WT. The course of the prevertebral segment of the vertebral artery, anatomy and clinical significance. Surg Neurol.. 1997;48(2):125-31.

Carlson DH, McDonald DG. Simplified catheterization of a left common carotid artery arising from the innominate trunk. Radiology. 1982;144.

Azakie A, McElhinney DB, Messina LM, Stoney RJ. Common brachiocephalic trunk: strategies for revascularization. Ann Thorac Surg. 1999;67(3):657-60.

Komiyama M, Morikawa T, Nakajima H, Nishikawa M, Yasui T. High incidence of arterial dissection associated with left vertebral artery of aortic origin. Neurol Med Chir (Tokyo). 2001;41(1):8-11.

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