Lazaridis Nikolaos, Piagkou Maria, Loukas Marios, Piperaki Evangelia-Theophano, Totlis Trifon, Noussios Georgios, Natsis Konstantinos
Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece.
Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Surg Radiol Anat. 2018 Jul;40(7):779-797. doi: 10.1007/s00276-018-1987-3. Epub 2018 Feb 19.
Several congenital anomalies regarding the right (RVA) and left (LVA) vertebral artery have been described. The current paper aims to perform a systematic literature review of the variable vertebral artery (VA) origin from the aortic arch (AOA) and its branches. The incidence of these variants and the ensuing AOA branching pattern are highlighted. Atypical origin cases were found more commonly unilaterally, while LVA presented the majority of the aberrancies. The LVA emersion from the AOA (3.6%) and the RVA from the right common carotid artery (RCCA) (0.14%) were the commonest origin variations. Aberrant RVA origin as last branch of the AOA is very rare. Eighteen cases (0.12%) with an aberrant right subclavian artery (ARSCA) were found. Among them, the RVA originated from the RCCA and right subclavian artery in 94.4 and 5.6%, respectively. Sporadic cases had an AOA origin bilaterally; RVA and LVA had a double origin in 0.027 and 0.11%, respectively. A dual origin was detected in 0.0069%, bilaterally. The atypical VA origin may coexist with: (i) an ARSCA, (ii) a common origin of brachiocephalic artery and left common carotid artery (the misnomer bovine arch) and (iii) a bicarotid trunk. The aberrant VA origin favors hemodynamic alterations, predisposing to cerebrovascular disorders and intracranial aneurysm formation. Detailed information of VA variants is crucial for both endovascular interventionists and diagnostic radiologists involved in the treatment of patients with cerebrovascular disease. Such information may prove useful to minimize the risk of VA injury in several procedures.
关于右（RVA）和左（LVA）椎动脉的几种先天性异常已被描述。本文旨在对源自主动脉弓（AOA）及其分支的变异椎动脉（VA）进行系统的文献综述。重点介绍了这些变异的发生率以及随之而来的AOA分支模式。非典型起源病例更常见于单侧，而LVA出现的异常情况居多。LVA从AOA发出（3.6%）以及RVA从右颈总动脉（RCCA）发出（0.14%）是最常见的起源变异。作为AOA最后一个分支的异常RVA起源非常罕见。发现18例（0.12%）异常右锁骨下动脉（ARSCA）病例。其中，RVA分别起源于RCCA和右锁骨下动脉的比例为94.4%和5.6%。散发病例为双侧AOA起源；RVA和LVA双起源的比例分别为0.027%和0.11%。双侧检测到双起源的比例为0.0069%。非典型VA起源可能与以下情况共存：（i）ARSCA，（ii）头臂干和左颈总动脉共同起源（错误命名的牛型主动脉弓）以及（iii）双颈动脉干。异常VA起源有利于血流动力学改变，易导致脑血管疾病和颅内动脉瘤形成。VA变异的详细信息对于参与脑血管疾病患者治疗的血管内介入医生和诊断放射科医生都至关重要。这些信息可能有助于在多种手术中降低VA损伤的风险。
