Arcot Karthikeyan M, DeOrchis Vincent S
St. Francis Hospital & Heart Center 100 Port Washington Blvd, Roslyn, NY 11576, USA.
Department of Neurology, New York University Langone Hospital Long Island 259 First St, Mineola, NY 11501, USA.
Neurol Int. 2024 Oct 17;16(5):1158-1163. doi: 10.3390/neurolint16050087.
Embryologically, the left brachiocephalic vein (LBV) originates as an anastomotic channel between the right and left anterior cardinal veins. This positions the LBV between the manubrium sterni anteriorly and the innominate artery posteriorly. This pattern of adjacency of the aorta to the LBV is unique to mammals and results from a quirk of evolution. With age, the ascending aorta unfolds, elongates and dilates. Simultaneously, there is a change in the thoracic geometry that reduces the thoracic volume primarily from disc height loss and kyphosis. These transitions progressively compress the LBV. Normally, this compression is circumvented via collateral pathways and "Blood finds a way". However, traversing these circuitous pathways comes at a cost and can result in delayed transit times and venous congestion. While it is possible that compression of the LBV in the setting of adequate collateral channels may fail to provoke any pathologic sequelae, we propose a phenomenon in which such compression in the setting of inadequate collateral circulation may lead to a state of pathologic venous congestion. This anatomic anomaly and its associated clinical features, if identified, can offer a new avenue for treatment options for some of the hitherto unexplained neurologic disorders.
从胚胎学角度来看，左头臂静脉（LBV）起源于左右前主静脉之间的吻合通道。这使得LBV位于前方的胸骨柄和后方的无名动脉之间。主动脉与LBV的这种相邻模式是哺乳动物所特有的，是进化过程中的一个奇特现象。随着年龄的增长，升主动脉展开、伸长并扩张。同时，胸廓几何形状发生变化，主要由于椎间盘高度降低和脊柱后凸导致胸廓容积减小。这些变化逐渐压迫LBV。正常情况下，这种压迫可通过侧支循环途径得以避免，正所谓“血流自有其道”。然而，通过这些迂回路径会付出代价，可能导致传输时间延迟和静脉充血。虽然在有足够侧支通道的情况下，LBV受压可能不会引发任何病理后果，但我们提出一种现象，即在侧支循环不足的情况下，这种压迫可能导致病理性静脉充血状态。这种解剖学异常及其相关临床特征一旦被识别，可为一些迄今为止无法解释的神经系统疾病提供新的治疗选择途径。
