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Two exceptionally rare branching patterns of the aortic arch
Thomas Kau, Johann Gasser, Gerald Lesnik, Maria Sinzig, Klaus A Hausegger
To cite this version:
Thomas Kau, Johann Gasser, Gerald Lesnik, Maria Sinzig, Klaus A Hausegger. Two exceptionally rare branching patterns of the aortic arch. Vascular Medicine, SAGE Publications, 2008, 13 (1), pp.89-90. �10.1177/1358863X07085517�. �hal-00571374�
Images in vascular medicine
Two exceptionally rare branching patterns of the aortic arch
Thomas Kau, Johann Gasser, Gerald Lesnik, Maria Sinzig and Klaus A Hausegger
Magnetic resonance angiography of the thoracic aorta was performed in a 66-year-old man scheduled for a Ben- tall operation. Beside the known aneurysm of the ascend- ing aorta, a rare variant branching sequence of the aortic arch was found (Panel A:view from posterior; R, right; ls, left subclavian artery; lv, left vertebral artery; lc, left com- mon carotid artery; rv, right vertebral artery; rc, right common carotid artery; rs, right subclavian artery).
Three-dimensional surface reconstructions depicted a
common brachiocephalic trunk (asterisk), in which both common carotid arteries and the right subclavian artery arose from a single trunk off the arch. This so-called
‘bovine trunk’(misnomer1) was combined with a regular origin of the left subclavian artery and a very uncommon variant that may be called‘arteria vertebralis lusoria’, in which the right vertebral artery (long arrow) is the last branch of the aortic arch and courses to the right behind the trachea (short arrow) and esophagus (Panel B:maxi- mum intensity projection image; v, ventral; d, dorsal; T, trachea).2 Goray, et al. hypothesized that this variant developed from the C8 intercostal artery with secondary proximal migration.3 Our patient was asymptomatic in this regard with no sign of a swallowing disorder.
Only 1 week later, a 38-year-old woman was referred for magnetic resonance angiography of the thoracic aorta with suspicion of dysphagia lusoria on the basis of barium swallow (Panel C: view from posterior;
Panel A Panel B
Institute of Diagnostic and Interventional Radiology, Federal Hospital of Klagenfurt, Klagenfurt, Austria
Correspondence to: Thomas Kau, LKH Klagenfurt, IDIR, St Veiter Strasse 47, A-9020 Klagenfurt, Austria.
Email: t.kau@gmx.at
Vascular Medicine2008;13:89–90
© 2008 SAGE Publications, Los Angeles, London, New Delhi and Singapore 10.1177/1358863X07085517
abbreviations as in Panel A). Three-dimensional imaging confirmed the diagnosis of an arteria lusoria with the right subclavian artery being the last branch of the aortic
arch.4Further, a variant origin of the vertebral arteries was found. The right vertebral artery originated from the right common carotid artery, while the left vertebral artery directly arose from the aortic arch between the left common carotid and subclavian arteries.2
The branching patterns in this report represent excep- tionally rare combinations of variant vascular anatomy.
With the exception of arteria subclavia lusoria, anoma- lous branching of the aortic arch usually does not result in clinical symptoms. The true value of detecting an anomalous origin is in the diagnostic gain for planning aortic arch surgery or endovascular intervention. An aberrant origin of the vertebral arteries also represents a potential pitfall following trauma to the neck.3
References
1 Layton, KF, Kallmes, DF, Cloft, HJ, Lindell, EP, Cox, VS.
Bovine aortic arch variant in humans: clarification of a com- mon misnomer. AJNR Am J Neuroradiol2006;27: 1541–
1542.
2 Lemke, AJ, Benndorf, G, Liebig, T, Felix, R. Anomalous origin of the right vertebral artery: review of the literature and case report of the right vertebral artery origin distal to the left subclavian artery.AJNR Am J Neuroradiol1999;20: 1318–1321.
3 Goray, VB, Joshi, AR, Garg, A, Merchant, S, Yadav, B, Maheshwari, P. Aortic arch variation: a unique case with anomalous origin of both vertebral arteries as additional branches of the aortic arch distal to left subclavian artery.
AJNR Am J Neuroradiol2005;26: 93–95.
4 Bayford, D. An account on a singular case of obstructed deglutition. Memoirs of the Medical Society of London 1794;2: 271–82.
‘Images in vascular medicine’ is a regular feature of Vascular Medicine. Readers may submit original, unpublished images related to clinical vascular medicine to: Mark A Creager, Editor in Chief, Vascular Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA.
Panel C
90 T Kau et al.
Vascular Medicine2008;13:89–90
