Pandalai Uma, Pillay Minnie, Moorthy Srikanth, Sukumaran Tintu T, Ramakrishnan Swapna, Gopalakrishnan Asha, Gopalakrishna Pillai Anandhu Krishnan
Anatomy, University of Hafr Al Batin, Riyadh, SAU.
Anatomy, Amrita Institute of Medical Sciences and Research, Kochi, IND.
Cureus. 2021 Feb 3;13(2):e13115. doi: 10.7759/cureus.13115.
Introduction Despite adequate preparation and meticulous pre-operative assessment, variations of the vascular anatomy of the aortic arch may lead to clinical dilemmas. In the present era, with the easy availability of imaging facilities, various anatomical variations can be found out prior to an interventional procedure. However, there are many countries including India where such facilities may still be not widely available. The purpose of this study was to assess the prevalence of these anatomical variants in patients undergoing Computerised Tomography (CT) chest with contrast. Methods This observational study involved patients who underwent CT chest with contrast as part of various clinical indications during a three-year period in a tertiary care centre in South India. Variations of the aortic arch and its branching pattern were studied in 4,000 chest CT images of patients referred to the radiology department. Results A total of 4,000 patients underwent CT chest with contrast during the study period. Twenty-seven variations were observed in these patients. They included aberrant right subclavian artery in seven patients, bovine arch in one patient, bovine origin of left vertebral artery from arch in one patient, bronchial artery of anomalous origin from arch in one patient, double aortic arch in one patient, and right-sided aortic arch in 16 patients. Conclusion The variant anatomy of the aortic arch has tremendous clinical significance, especially from the surgical standpoint. Anatomical variants can also cause difficulty during catheterization while performing endovascular interventions. Given the prevalence demonstrated in our study, imaging may be indicated prior to any procedure involving vascular access in order to prevent unwanted complications.
引言 尽管准备充分且进行了细致的术前评估，但主动脉弓血管解剖结构的变异仍可能导致临床困境。在当今时代，随着影像设备的便捷可得，在介入手术前可发现各种解剖变异。然而，包括印度在内的许多国家，此类设备可能仍未广泛普及。本研究的目的是评估接受胸部增强计算机断层扫描（CT）的患者中这些解剖变异的发生率。方法 这项观察性研究纳入了在印度南部一家三级医疗中心三年内因各种临床指征接受胸部增强CT的患者。在转诊至放射科的4000例患者的胸部CT图像中研究了主动脉弓及其分支模式的变异情况。结果 在研究期间，共有4000例患者接受了胸部增强CT检查。在这些患者中观察到27种变异情况。其中包括7例异常右锁骨下动脉、1例牛型主动脉弓、1例左椎动脉起自主动脉弓的牛型起源、1例支气管动脉起自主动脉弓的异常起源、1例双主动脉弓以及16例右侧主动脉弓。结论 主动脉弓的变异解剖结构具有重大临床意义，尤其是从手术角度来看。解剖变异在进行血管内介入操作时的导管插入过程中也可能造成困难。鉴于我们研究中显示的发生率，在任何涉及血管通路的手术前可能都需要进行影像学检查，以预防不必要的并发症。
