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

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 methods: 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 biinnominate 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.Key words: Aortic arch, vertebral artery, brachiocephalic trunk, variations. ResumoObjetivos: Determinar a porcentagem e o tipo de variações do arco aórtico em indivíduos indianos, bem como sua importância clí-nica 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 anatômi-cos das ramificações do arco a...

Caracterizacion de las Ramas del Arco Aórtico en una Muestra de Poblacion Colombiana: Un Estudio con Material de Autopsia

“…procedimientos hemodinámicos, en la etiología de las lesiones cerebrales derivadas de la manipulación de estos vasos y en el manejo del trauma torácico superior y del cuello. El desconocimiento de las expresiones variantes de las ramas derivadas del AA puede precipitar la ocurrencia de iatrogenias durante los procedimientos quirúrgicos (Matula et al;Satyapal et al;Nayak et al, 2006;Jakanani & Adair). La evaluación de la emergencia de las ramas del AA ha sido sido realizada en grupos poblacionales variados y a través de métodos anatómicos convencionales e imagenológicos (De Garis et al, 1933;Grande et al, 1995;Satyapal et al;Bathia et al;Yamaki et al;Berko et al;Natsis et al, 2009;Bhattarai & Poudel, 2010;Ogeng'o et al, 2010;Alsaif & Ramadan).…”

Cadaveric Study of Branches of Arch of Aorta

“…Entry point of the LVA originating from the aortic arch, into the Foramen transversarium was also reported variable. Most common entry points were reported as C5 and C6, respectively Overall, the most common entrance for vertebral arteries was at C6 [11]. In the present case, the left sixth dorsal intersegmental artery may have persisted as the first part of vertebral artery hence left vertebral artery began from arch of aorta.…”

“…In approximately 6% of the population the left vertebral artery arises from the arch of aorta, usually between left common carotid and left Origin point of the VA has also been reported from the thyrocervical trunk, from the brachiocephalic trunk, from the common carotid artery, from the external carotid artery, from a trunk formed by LSA and LVA [11][12][13][14][15].…”

Anatomical Features and Clinical Importance of the Vertebral Artery

“…Several researches have reported anomalous origin, in which origin point of the VA is from the aortic arch [1,[8][9][10][11][12][13][14][15], from the thyrocervical trunk [1,14,16], from the brachiocephalic trunk [6], from the common carotid artery [1,14,17], and from the external carotid artery [1,12,14]. Though the overall incidence of the anomalous origin of the VA is low, it occurs mostly on one side, usually on the left [11,12].…”