Arcus Aortae’de İki Vasküler Varyasyon: Olgu Sunumu

Abstract

Amaç: Arcus aortae’nin konveksliğinden sırasıyla sağdan sola doğru truncus brachiocephalicus, arteria carotis communis sinistra ve arteria subclavia sinistra dalları çıkar. Her iki tarafta boyun kökünün derininde arteria subclavia’nın ilk dalı olan arteria vertebralis yukarı doğru biraz uzandıktan sonra ilk altı cervical vertebra’nın foramen transversarium’larından geçerek foramen magnum’dan kafa boşluğuna girer. Çalışmamızın amacı, vakamızda gözlemlenen arcus aortae’de yer alan vasküler varyasyonları sunmaktır. Olgu sunumu: Rutin otopsi sırasında 9 yaşındaki kız çocuk olguda, arcus aortae’de varyasyon gözlemlendi. Tip 2B1 varyasyonu, truncus brachiocephalicus ve arteria carotis communis sinistra'nın beklenen mesafeden daha yakın veya bitişik olduğu durumu ifade ederken; Tip 4B1 varyasyonu, arteria carotis communis sinistra ile arteria subclavia sinistra arasında arteria vertebralis sinistra'nın orjin aldığı gözlemlendi. Sonuç: Bu olgu sunumu, tespit edilen varyasyonların anatomik yapıları ve klinik önemleri üzerine bilgi sağlamayı amaçlamaktadır. Arcus aorta’dan çıkan dalların ve varyasyonların bilinmesi önemlidir. Çünkü aort ve dallarına yönelik cerrahi veya endovasküler girişimsel işlemler sırasında trakeoözofageal basıya bağlı komplikasyonlara neden olabilir. Bu vaka incelemesi ile tespit edilen anatomik varyasyonların, klinik ve cerrahi yaklaşımlarda faydalı olabileceğini düşünmekteyiz.

Keywords

• Anatomik varyasyon
• arteria vertebralis
• truncus brachiocephalicus
• otopsi

Two Vascular Variations in the Aortic Arch: A Case Report

Abstract

Objective: From the convexity of the aortic arch, the branches that arise from right to left are the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery. On both sides, the first branch of the subclavian artery, the vertebral artery, ascends slightly upward, passing through the foramina transversaria of the first six cervical vertebrae and entering the cranial cavity through the foramen magnum. The aim of our study is to present the vascular variations observed in the aortic arch in our case. Case report: During a routine autopsy of a 9-year-old female child, two different vascular variations were observed. Type 2B1 variation refers to the condition where the brachiocephalic trunk and the left common carotid artery are closer or adjacent to each other than expected. In Type 4B1 variation, it was observed that the left vertebral artery originates between the left common carotid artery and the left subclavian artery. Conclusion: This case report aims to provide information on the anatomical structures and clinical significance of the identified variations. It is important to know the branches and variations arising from the aortic arch, as they can cause complications due to tracheoesophageal compression during surgical or endovascular interventional procedures involving the aorta and its branches. We believe that the anatomical variations identified in this case study may be useful in clinical and surgical approaches

Keywords

• Anatomical variation
• vertebral artery
• brachiocephalic trunk
• autopsy

References

1. 1. Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. Elsevier; 2020.
2. 2. Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer; 2018.
3. 3. Kies SM, Becker AE, Gittenberger-de Groot AC. Morphogenesis of the Heart and Great Vessels. In: Gittenberger-de Groot AC, Poelmann RE, editors. Development of the Heart and Vascular System. Springer; 2021;123-50.
4. 4. McElroy MJ, El-Sayed AM, Anderson JB. Vascular anomalies and their significance in the management of head and neck tumors. J Vasc Surg. 2019;69(1):131-45.
5. 5. Natsis K, Piagkou M, Lazaridis N, Kalamatianos T, Chytas D, Manatakis D, et al. A systematic classification of the left-sided aortic arch variants based on cadaveric studies’ prevalence. Surg Radiol Anat. 2021;43(3):327–45.
6. 6. Açar B, Tatar İ, Kara İ, Yılmaz Ö, Kaplan S. Evaluation of aortic arch variations with computed tomography angiography. J Med Imaging Radiat Oncol. 2022;66(3):293-300.
7. 7. Bae SB, Kang E, Choo K, Lee J, Kim SH, Lim KJ, et al. Aortic arch variants and anomalies: embryology, imaging findings, and clinical considerations. J Cardiovasc Imaging. 2022;30:231-62.
8. 8. Tawfik A, Sobh D, Ashamallah GA, Batouty NM. Prevalence and types of aortic arch variants and anomalies in congenital heart diseases. Acad Radiol. 2019;26(7):930-6.

9. 9. Gürkan S, Özkaramanlı Gür D, Gür Ö, Donbaloğlu MO. ‘Bovine Ark’ anomalisi ve subklavyan çalma sendromu olan hastanın başarılı endovasküler tedavisi. Damar Cer Derg. 2016;25(1):39-42.
10. 10. Lippert H, Pabst R. Arterial Variations in Man: Classification and Frequency. Springer-Verlag; 1985.
11. 11. Woraputtaporn W, Sahasakul Y, Akazawa M, Itoh S, Matsumoto S, Hosoi M. Anatomical variations of the aortic arch branches: a retrospective study based on multi-detector computed tomography angiography. Surg Radiol Anat. 2019;41(12):1425-31.
12. 12. Lee SH, Park JH, Shin DH. Preoperative imaging of the aortic arch and its branches in patients undergoing cardiovascular surgery. Cardiovasc Intervent Radiol. 2019;42(7):987-94.
13. 13. Tanaka K, Kato S, Nakajima T. The impact of anatomic variations of the aortic arch and great vessels on transcatheter aortic valve implantation. J Cardiol. 2017;70(3):287-93.
14. 14. Bergman RA, Afifi AK, Miyauchi R. Illustrated Encyclopedia of Human Anatomic Variation. Opus Publications; 2016.
15. 15. Skandalakis JE, Gray SW. Embryology for Surgeons. 4th ed. Williams & Wilkins; 2019.
16. 16. Kato S, Tanaka K, Nakajima T. The role of anatomical variations in cardiovascular surgery: current perspectives. J Cardiovasc Surg. 2018;59(4):123-9.
17. 17. Williams PL, Warwick R, Dyson M, Bannister LH. Gray’s Anatomy. 39th ed. Churchill Livingstone; 2020.