Arteria Subclavia ve Ana Dallarının Çok Kesitli Bilgisayarlı Tomografi (ÇKBT) ile Morfolojik ve Morfometrik Analizi

Abstract

Amaç: Bu çalışmada çok kesitli bilgisayarlı tomografi aracılığı ile arteria subclavia’nın (AS) ve dallarının morfolojik ve morfometrik analizinin ortaya konması amaçlanmıştır Gereç ve Yöntem: Çalışmada, 100 hastaya ait bilgisayarlı tomografi anjiografi görüntüleri (100 sağ, 100 sol) incelenmiştir. Varyasyonel vakalar tespit edilmiş, AS’nin ve dallarının orijin noktasındaki çapları ve AS’nin iki tarafta başlangıç noktasında oluşan açılanmaları ölçülmüştür. Bulgular: AS’nin dalları için 13 farklı varyasyon nonlineer tarzda (A0, A1, A6, B0, B1, B2, B3, B4, B5, B7, C0, C1, C7 tipleri) tiplendirilmiştir (A0:%54, B0:%33, diğer tiplerin toplamı: %13). Varyasyon tiplerinin cinsiyete ve taraflara göre karşılaştırılmasında, kısmen birleştirilmiş varyasyon grupları arasında istatistiki olarak anlamlı fark bulunmamıştır. AS ve dallarının morfometrik verileri (ayrılma açısı ve başlangıç çap ölçümleri) cinsiyete ve tarafa göre karşılaştırıldığında, her iki cinsiyette başlangıç noktasında, AS sinistra çapının (kadın: 11,87±2,20 mm, erkek: 12,41±1,94 mm), AS dextra çapından (kadın: 9,10±2,31 mm, erkek: 9,78±1,84 mm) istatistiki olarak anlamlı derecede yüksek olduğu tespit edilmiştir. Aynı şekilde, her iki cinsiyette AS sinistra açısı (kadın: 92,75±36,26, erkek: 84,77±24,24), AS dextra açısından (kadın: 42,70±14,44, erkek: 40,10±16,73) istatistiki olarak anlamlı derecede yüksek çıkmıştır. Sonuç: AS’nin kanlandırdığı bölgelerin geniş ve önemli olması ve kritik bir noktada arteriyel bir kavşak görevinde bulunması, AS ve dalları ile ilgili morfometrik ve varyasyonel verilere klinik tıp sahasında ihtiyaç doğurmaktadır. AS’nin morfometrik analizi ile ilgili bilgilerin bu alanda çalışan klinisyenler için faydalı olacağını ümit ediyoruz.

Keywords

• Arteria subclavia
• ÇKBT
• morfometri
• morfoloji
• varyasyon

Morphologic and Morphometric Analysis of the Subclavian Artery and the Main Branches of the Subclavian Artery by Multidetector Computerized Tomography (MDCT)

Abstract

Objective: We aimed to investigate the morphologic and morphometric analysis of the subclavian artery (SA) by using multidetector computed tomography Material and Method: In this study, Computed Tomography Angiography images of 100 patients (100 right, 100 left) were studied. Variational cases were detected, and the angle that appeared origin of SA, as well as the diameters corresponding to the origin of SA and of its branches, were measured. Results: Thirteen different variations have been described while performing classification in non-linear base (A0, A1, A6, B0, B1, B2, B3, B4, B5, B7, C0, C1, C7 types) for the ramification patterns of subclavian artery (A0:54%, B0:33%, other types total:13%). No significant differences were observed on partially united variation types between sexes and both sides. Morphometric data of the subclavian artery and its branches (separation angle and initial diameter measurement) were studied in a comparative statistical analysis based on sex and lateralization. This analysis showed statistically significant results in the comparison of the mean diameters of SA at the starting point between sides, on both sexes [left SA: (female: 11.87±2.20 mm, male: 12.41±1.94 mm), right SA (female: 9.10±2.31 mm, male: 9.78±1.84 mm) (p<0.05). Likewise, there was a statistically significant difference between the left SA angle and right SA angle measurements [left SA angle: (female: 92.75±36.26, male: 84.77±24.24), right SA angle: (female: 42.70±14.44, male: 40.10±16.73)] on both sexes. Conclusion: As the area in which the blood is being supplied by SA is wide and important, and its function is to serve as a crucial arterial intersection, morphometric data and variations regarding SA and its branches are needed in the field of medicine. We hope this study may contribute to the literature in this field of research and be helpful for clinicians interested in SA.

Keywords

• subclavian artery
• MDCT
• morphometry
• Morphology
• variation

References

1. Tunali S. Subclavian Artery. In: Tubbs RS, Shoja MM, Loukas M, editors. Bergman's Comprehensive Encyclopedia of Human Anatomic Variation. Hoboken, New Jersey, ABD: John Wiley & Sons, Inc.; 2016. p. 575-82.
2. George B, Bruneau M. Vertebral Artery. In: Tubbs RS, Shoja MM, Loukas M, editors. Bergman's Comprehensive Encyclopedia of Human Anatomic Variation. Hoboken, New Jersey, ABD: John Wiley & Sons, Inc.; 2016. p. 487-500.
3. Branscom JJ, Austin JHM. Aberrant right subclavian artery: findings seen on plain chest roentgenograms. Am J Roentgenol Radium Ther Nucl Med. 1973;119(3):539-42.
4. Freed K, Low V. The aberrant subclavian artery. AJR Am J Roentgenol. 1997;168(2):481-4.
5. Turkenburg J, Versteegh M, Shaw PC. Case report: aneurysm of an aberrant right subclavian artery diagnosed with MR imaging. Clin Radiol. 1994;49(11):837-9.
6. Jebara VA, Oussouldjogli E, Rassi I, Tabet G, Fabre-Bouabboud V. Aberrant right subclavian artery aneurysm--a surgical review. J Med Liban. 1995;43(3):157-61.
7. Hogg JP, Dominic AJ, Counselman RL, Hurst JL. Expanding aneurysm of aberrant right subclavian artery. Case report and imaging evaluation. Clin Imaging. 1997;21(3):195-9.
8. Godlewski J, Widawski T, Michalak M, Kmiec Z. Aneurysm of the aberrant right subclavian artery - a case report. Pol J Radiol. 2010;75(4):47-50.

9. Ballı HT. Subklavyen arter tıkayıcı hastalıklarında endovasküler tedavi [Uzmanlık Tezi]. [Adana]: Çukurova Üniversitesi; 2009. 75 p.
10. Zheng Y, Wang H, Liu Y, Zhao A, Pan X, Guo Y, et al. Aberrant Branches of the Subclavian Artery and their Relationship with the Phrenic Nerve and the Brachial Plexus. Int J Morphol. 2022;40(2):433-5.
11. Zhu Y, Zheng Q, Liao H, Mei J, Kocher GJ, Shimizu K, et al. Successful thoracoscopic management of iatrogenic left subclavian arterial injury: a case report. J Thorac Dis. 2022;14(1):194-8.
12. Reyna J, Peguero JG, Elmahdy HM, Santana O, Conde C. Subclavian artery stenosis: a case series and review of the literature. Rev Cardiovasc Med. 2014;15(2):189-95.
13. Abraham V, Mathew A, Cherian V, Chandran S, Mathew G. Aberrant subclavian artery: anatomical curiosity or clinical entity. Int J Surg. 2009;7(2):106-9.
14. Karaman B, Battal B, Bozkurt Y, Bozlar U, Demirkol S, Sahin MA, et al. The anatomic evaluation of the internal mammary artery using multidetector CT angiography. Diagn Interv Radiol. 2012;18(2):215-20.
15. Tetiker H. Arteria Vertebralislerin V2 ve V3 segmentlerinin seyri ve morfolojik özellikleri [Uzmanlık Tezi]. [Sivas]: Cumhuriyet Üniversitesi; 2010. 65 p.
16. Matula C, Trattnig S, Tschabitscher M, Day J, Koos WT. The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol. 1997;48(2):125-31.
17. Uygur R, Akyüz A, Akkoyun DÇ, Alpsoy Ş, Çağlar V. Sol internal torasik arterin proksimalinden çıkan gelişmiş aksesuar yan dal ve klinik önemi. Genel Tıp Derg. 2013;23(4):127-9.
18. Turkvatan A, Buyukbayraktar FG, Olcer T, Cumhur T. Multidetector computed tomographic angiography of aberrant subclavian arteries. Vasc Med. 2009;14(1):5-11.
19. Uemura M, Takemura A, Ehara D, Yasumitsu H, Ohnishi Y, Suwa F. Comparative study of the ramification patterns of the subclavian branches as the subclavian artery passes in front or behind the scalenus anterior muscle. Anat Sci Int. 2010;85(3):160-6.
20. Poultsides GA, Lolis ED, Vasquez J, Drezner AD, Venieratos D. Common origins of carotid and subclavian arterial systems: report of a rare aortic arch variant. Ann Vasc Surg. 2004;18(5):597-600.
21. Prokop M. General principles of MDCT. Eur J Radiol. 2003;45:S4-S10.
22. Gluncic V, Ivkic G, Marin D, Percac S. Anomalous origin of both vertebral arteries. Clin Anat. 1999;12(4):281-4.
23. Yılmaz MT. Aorta Abdominalis ve dallarının multidedektör BT anjiografi yöntemi ile morfometrik analizi [Doktora Tezi]. [Konya]: Selçuk Üniversitesi; 2011. 141 p.
24. Manole A, Iliescu D, Rusali A, Bordei P. Morphometry of the aortic arch and its branches. ARS Medica Tomitana. 2013;19(3):154-9.
25. Gao J, Li W, Zhu J, Liu Y, Tian H. Ultrasound Evaluation of Subclavian Artery and Internal Thoracic Artery Before Coronary Artery Bypass Grafting as Part of Preoperative Vascular Assessment. Acad Radiol. 2022;S1076-6332(22)00333-6.
26. Tarnoki AD, Fejer B, Tarnoki DL, Littvay L, Lucatelli P, Cirelli C, et al. Vertebral Artery Diameter and Flow: Nature or Nurture. J Neuroimaging. 2017;27(5):499-504.
27. Vorster W, du Plooy PT, Meiring JH. Abnormal origin of internal thoracic and vertebral arteries. Clin Anat. 1998;11(1):33-7.
28. Arıncı K, Elhan A. Anatomi. 5th ed. Ankara, Türkiye: Güneş Tıp Kitabevleri; 2014. 856 p.
29. Moore KL, Agur AMR, Dalley AF. Essential clinical anatomy. 5th ed. China: Lippincott Williams & Wilkins; 2014. 686 p.
30. Sadler TW. Langman's Medical Embryology. 13th ed. China: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011. 407 p.
31. Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th ed. UK: Churchill Livingstone Elsevier; 2008. 1551 p.
32. Moore KL, Persaud TVN, Torchia MG. Embriyoloji ve doğum defektlerinin temelleri: biz doğmadan önce (Tercüme: Müftüoğlu, S. Kaymaz, F. Atilla, P.). 7th ed. Ankara: Güneş Tıp Kitabevleri; 2009. 356 p.
33. Abhaichand RK, Louvard Y, Gobeil JF, Loubeyre C, Lefevre T, Morice MC. The problem of arteria lusoria in right transradial coronary angiography and angioplasty. Catheter Cardiovasc Interv. 2001;54(2):196-201.
34. Yiu KH, Chan WS, Jim MH, Chow WH. Arteria lusoria diagnosed by transradial coronary catheterization. JACC Cardiovasc Interv. 2010;3(8):880-1.
35. Saadeh FA, El-Sabban M. Rare variations of the left subclavian artery. Clin Anat. 2005;18(5):370-2.
36. Kim Y-D, Yeo H-T, Cho Y-D. Anomalous variations of the origin and course of vertebral arteries in patients with retroesophageal right subclavian artery. J Korean Neurosurg Soc. 2009;45(5):297-9.
37. 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(1):93-5.
38. Khanafer KM, Bull JL, Upchurch GR, Berguer R. Turbulence significantly increases pressure and fluid shear stress in an aortic aneurysm model under resting and exercise flow conditions. Ann Vasc Surg. 2007;21(1):67-74.
39. Acar S. Yetişkin bireylerde arcus aortae ve dallarının multidedektör computerize tomografi anjiografi yöntemi ile morfometrik analizi. [Doktora Tezi]. [Konya]: Selçuk Üniversitesi; 2013. 70 p.
40. Saladin KS. Anatomy & physiology: the unity of form and function. 5th ed. NewYork: McGraw-Hill; 2017. 813 p.
41. Daseler EH, Anson BJ. Surgical anatomy of the subclavian artery and its branches. Surg Gynecol Obstet. 1959;108(2):149-74.