Variations of vertebral artery: Multidetector Computerized Tomographic Angiography Study

Abstract

Objective: The aims of this study are detecting Turkish Society’s vertebral artery variationsidentified on MDCT angiograpy and determining origin variations of vertebral arteries and theirarising level from subclavian artery.Materials and Methods: MDCT angiographic images of 96 patiens (31-86 years old, 64 maleand 32 female) were evaluated. Images were obtained using 64 slice multidedector CT scanimages of vertebral artery.Results: In this study, investigations of origin levels of vertebral arteries showed vertebral arterymostly originated from Th1-2 vertebrae in males and vertebral artery mostly originated fromTh1 vertebrae in females. In six different vertebral artery cases variations were detected. Amongthese variations, in four cases vertebral arteries originated from aortic arch (4.1%), in one casevertebral artery is originated from common carotic artery (1%). One patient’s (1%) left vertebralartery was absent, the right vertebral artery alone created basilar artery in the basis cranii.Conclusions: Knowledge of vertebral artery variations that were frequently detected in Turkishsociety is important in explaining the symptoms of vertebrobasiler insufficiency. Identificationof these variations will be very useful for neurology, neurosurgery and cardiovascular surgeryspecialists and radiologists

Keywords

• Arteria vertebralis,variation,multidetector CT angiograpy

ARTERİA VERTEBRALİS’İN VARYASYONLARI: MULTİDEDEKTÖR BİLGİSAYARLI TOM

Abstract

Amaç: Bu çalışmanın amacı Türk Toplumu’na ait arteria vertebralis’e ait varyasyonları MDBTangiographi’de tespit edip, arteria vertebralis’in sık görülen orjin varyasyonlarını ve arteriasubclavia’dan çıkış seviyelerini belirlemektir.Gereç Yöntem: Arteria vertebralis’e ait 64 kesitli MDBT imajları kullanılarak oluşturulan (3186 yaş arası 64 erkek, 32 kadın) 96 hastanın MDBT angiographi görüntüleri incelendi.Bulgular: Çalışmada arteria vertebralis’in orjin seviyelerinin incelenmesinde erkeklerde enfazla Th1-2 vertebra, kadınlarda ise Th1 vertebra düzeyinden arteria vertebralis’in çıktığıgözlendi. Arteria vertebralis’e ait altı farklı vakada varyasyon tespit edildi. Bu varyasyonlardanA. vertebralis’in dört vakada arcus aortadan (% 4.1), bir vakada arteria carotis communis’ten(%1) köken aldığı, bir vakada ise sol tarafta olmadığı (%1) sağ arteria vertebralis’in kafatabanında tek başına arteria basillaris’i oluşturduğu tespit edildi.Sonuçlar: Türk Toplumu’nda oldukça sık görülen arteria vertebralis varyasyonlarının bilinmesivertebrobasiler yetmezlik semptomlarının açıklanmasında önemlidir. Bu varyasyonların tespitedilmesi nöroloji, nöroşirurji ve kardiyovasküler cerrrahi uzmanları ve radyologlar açısındançok faydalı olacaktır

Keywords

• Arteria vertebralis,varyasyon,multidedektör BT anjiografi

References

1. Arıncı K, Elhan A. Anatomi, 2 Cilt. 4. Baskı. Ankara: Güneş Kitabevi. 2006;40.
2. Eskander MS, Drew JM, Aubin ME, Marvin J, Franklin PD, Eck JC, Patel N, Boyle K, Connolly PJ. Vertebral Artery Anatomy A Review of Two Hundred Fifty Magnetic Resonance Imaging Scans. Spine. 2010;35:2035-2040.
3. Sanelli PC, Tong S, Gonzalez RG, Eskey CJ. Normal Variation of Vertebral Artery on CT Angiography and Its Implications for Diagnosis of Acquired Pathology. Journal of Computer Assisted Tomography. 2002;26(3):462-470.
4. Ka-Tak W, W. M. Lam W, C. H. Yu S. MDCT of an Aberrant Right Subclavian Artery and of Bilateral Vertebral Arteries with Anomalous Origins. AJR. 2007;188:274-275.
5. Güvençer M, Erdal AC, Tetik S. Arteria Vertebralis V1 Segmentinin Anatomik Özellikleri ve Cerrahi Önemi. DEÜ Tıp Fakültesi Dergisi. 2004;18(1):15-25.
6. Uchino A, Saito N, Takahashi M, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Nakajima R, Watanabe Y. Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography. Neuroradiology. 2013;55:585-594.
7. 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 Neuroradiol. 2005;26:93-95.
8. Karcaaltincaba M, Haliloglu M, Ozkan E, Kocak M, Akinci D, Ariyurek M. Non-invasive imaging of aberrant right subclavian artery pathologies and aberrant right vertebral artery. Br J Radiol. 2009;82:73-78.

9. Albayram S, Gailloud P, Wasserman BA. Bilateral arch origin of the vertebral arteries. Am J Neuroradiol. 2002;23:455-458.
10. Sikka A, Jain A. Bilateral Variation in the Origin and Course of the Vertebral Artery. Anatomy Research Int. 2012; 1-3.
11. Wasserman BA, Mikulis DJ, Manzione JV. Origin of the right vertebral artery from the left side of the aortic arch proximal to the origin of the left subclavian artery. Am J Neuroradiol. 1992;13:355-358.
12. 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. Am J Neuroradiol. 1999;20:1318-1321.
13. Jakanani GC, Adair W. Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol. 2010;65:481-487.
14. Berko NS, Jain VR, Godelman A, Stein EG, Ghosh S, Haramati LB Variants and anomalies of thoracic vasculature on computed tomographic angiography in adults. J Comput Assist Tomogr. 2009;33:523-528.
15. Müller M, Schmitz BL, Pauls S, Schick M, Röhrer S, Kapapa T, Schlötzer W Variations of the aortic arch-a study on the most common branching patterns. Acta Radiol. 2011;52:738- 742.
16. Meila D, Tysiac M, Petersen M, Theisen O, Wetter A, Mangold A, Schlunz-Hendann M, Papke K, Brassel F, Berenstein A. Origin and Course of the Extracranial Vertebral Artery: CTA Findings and Embryologic Considerations. Clin Neuroradiol. 2012;22:327-333.
17. Oğuz B, Yigit AE, Karlı Oğuz K, Haliloğlu M. MDCT angiography of right-sided aortic arch with aberrant left subclavian artery and duplicated left vertebral artery. International Journal of Anatomical Variations. 2010;3:15-18.
18. Al-Okaili R, Schwartz ED. Bilateral aortic origins of the vertebral arteries with right vertebral artery arising distal to left subclavian artery: case report. Surg Neurol. 2007;67:174- 176.
19. Karcaaltincaba M, Strottman J, Washington L. Multidetector- row CT angiographic findings in the bilateral aortic arch origin of the vertebral arteries. AJNR Am J Neuroradiol. 2003;24:157.
20. Mahmutyazicioglu K, Sarac K¸ Ayhan Boluk, Kutlu R. Duplicate Origin of Left Vertebral Artery with Thrombosis at the Origin: Color Doppler Sonography and CT Angiography Findings. Journal of Clinical Ultrasound. 1998;26(6):323-325.
21. Park JK, Kim SH, Kim BS, Choi G. Two Cases of Aberrant Right Subclavian Artery and Right Vertebral Artery that Originated from the Right Common Carotid Artery.
22. Strub WM, Leach JL, Tomsick TA. Left Vertebral Artery Origin from the Thyrocervical Trunk: A Unique Vascular Variant. AJNR Am J Neuroradiol. 2006;27:1155-56.
23. Chen CJ, Wang LJ, Wong YC. Abnormal Origin of the Vertebral Artery from the Common Carotid Artery. AJNR Am J Neuroradiol. 1998;19:1414-1416.
24. Dimmick SJ, Faulder KC. Normal Variants of the Cerebral Circulation at Multidetector CT Angiography. RadioGraphics. 2009;29:1027-1043.
25. Vaiman M, Beckerman I. Importance of preoperative detection of vertebral artery anomalies in neck surgery. ANZ J Surg. 2011;81;164-167.
26. Duan S, Lv S, Ye F, Lin Q. Imaging anatomy and variation of vertebral artery and bone structure at craniocervical junction. Eur Spine J. 2009;18:1102-1108.
27. Hong JT, Park DK, Lee MJ, Kim SW, An HS. Anatomical variations of the vertebral artery segment in the lower cervical spine: analysis by three-dimensional computed tomography angiography. Spine. 2008;33:2422-6.
28. Satti SR, Cerniglia CA, Koenigsberg RA. Cervical vertebral artery variations: an anatomic study. AJNR Am J Neuroradiol. 2007;28:976-980.
29. Ishihara H, San Millán Ruíz D, Abdo G, Asakura F, Yilmaz H, Lovblad KO, Rüfenacht DA. Combination of Rare Right Arterial Variation with Anomalous Origins of the Vertebral Artery, Aberrant Subclavian Artery and Persistent Trigeminal Artery A Case Report. Interventional Neuroradiology. 2011;17:339-342.
30. Uchino A, Saito N, Takeyuki W, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Inoue K, Nakajima R Takahashi M. Vertebral artery variations at the C1-2 level diagnosed by magnetic 2012;54:19-23. Neuroradiology.
31. Kao CL, Kuei-Ton Tsai, Jen-Ping Chang. Large Extracranial Vertebral Aneurysm with Absent Contralateral Vertebral Artery. Tex Heart Inst J. 2003;30:134-6.
32. Tuncer MC, Akgül YH, Karabulut Ö. MR Angiography Imaging of Absence Vertebral Artery Causing of Pulsatile Tinnitus: A Case Report. Int. J. Morphol. 2010;28(2):357-363.
33. Xie T, Zhang X.B, Li QP, Zhu W, Zhou H, Gu Y. Hemifacial spasm patient with ipsilateral total absence of common carotid artery, vertebral artery and aneurysm of the contralateral internal carotid artery. Surg Radiol Anat. 2010;32: 707-710.
34. Woodcock RJ, Cloft HJ, Dion JE. Bilateral Type 1 Proatlantal Arteries with Absence of Vertebral Arteries. AJNR Am J Neuroradiol 2001;22:418-420.
35. Vaiman M, Beckerman I, Eviatar E. Detection of anomalous vertebral arteries by ultrasound as an alternative to radiological methods. Eur Arch Otorhinolaryngol. 2011;268:1813-1816.