Learning objectives
The most common anomaly is the left vertebral artery arising from the aortic arch between the left common carotid and left subclavian artery.
Normally,
the left vertebral artery has an embryologic origin from the left 7th cervical intersegmental artery.
However,
an aberrant right vertebral artery is a rare anatomic variation with our case being an anomalous origin of the right vertebral artery originating from the aortic arch distal to the left subclavian artery.
This is the 14th case as per literature review presented in the...
Background
Embryological Perspective:
The right subclavian artery normally originates from the right primitive dorsal aorta.
The intersegmental arteries obliterate with the exception of the seventh which becomes the right subclavian artery.
This gives origin to the right vertebral artery with further formation of the right vertebral artery by development of intercostal longitudinal anastomosis between C1 and C7 cervical intersegmental arteries (CIA).
In our case,
the right vertebral artery arises from the C8 CIA with physiologic obliteration of the right dorsal aorta distal from the C7 CIA....
Findings and procedure details
Case:
54 year old woman presented for open lung biopsy.
A CT thorax was obtained which demonstrated an incidental finding of a right vertebral artery arising from the aortic arch distal to the left subclavian artery.
Clinical Significance:
Cases of anomalous origin of the vertebral artery are usually clinically asymptomatic,
however,
these anatomic variations can play a crucial role in avoiding vascular injury during cerebral angiography,
especially with unsuccessful vertebral artery catherization or in the setting of evaluating an intracranial aneurysm.
Furthermore,
these variations should...
Conclusion
Even though,
anomalous origins of the vertebral artery are only anatomic variants,
information of these anomalies is crucial for vascular surgery in the head and neck region,
esophageal,
mediastinal or tracheal surgeries or in cases of diagnostic cerebral angiography.
Understanding aberrant vascular anatomy must be considered if selective vertebral artery catheterization is difficult or unsuccessful.
References
1.Case,
David et al.
“Anomalous Right Vertebral Artery Originating from the Aortic Arch Distal to the Left Subclavian Artery: A Case Report and Review of the Literature.” Journal of Vascular and Interventional Neurology 8.3 (2015): 21–24.
2.Ligege P,
Scholtz L.
Rare variation in the origin of the right vertebral artery.
SA J Radiol.
2004.
pp.
34–35.
3.Lemke AJ,
Benndorf G,
Liebig T,
Felix R.
Anomalous origin of the right vertebralartery: Review of the literature and case report of right vertebral artery origin distal to the...