Duplicate Radial Artery Variation: A Comprehensive Analysis With Case Report, Literature Review, Embryological Insights and Clinical Significance.

Thorough knowledge of the anatomical variations of the arterial pattern of the upper limb is of high clinical importance in many medical fields, from surgery to nursery and anesthesiologic practice. During a routine dissection at the Anatomy Department of the Medical University of Plovdiv, a rare variation of the vascular system in the upper limb of a study cadaver was observed. The exhibited variation was the occurrence of a brachioradial artery (BRA) that ran along the main axis of the arm, superficially to the median nerve. After dissection of the cubital fossa, an unusually underdeveloped radial artery was also spotted. Per our knowledge, such a type of duplicate radial artery, the coexistence of a BRA and an underdeveloped radial artery has not been reported in the relevant literature on the topic. The underdeveloped radial artery gave a major branch, the recurrent radial artery, a branch usually given by the brachial artery or the BRA in case of a BRA variation. Variations in the arterial pattern could potentially give insight into the features of the embryological development of the vascular system.

Thyrolinguofacial trunk arising from the common carotid artery and diagnosed by computed tomography angiography.

PURPOSE: Various variations in the head and neck vasculature have been reported. The purpose of this report is to describe an extremely rare case of thyrolinguofacial trunk (TLFT) arising from the common carotid artery (CCA). METHODS: A 66-year-old woman with vertigo, dizziness, and heaviness in the head underwent computed tomography (CT) angiography of the neck and head region for evaluation of cerebrovascular diseases. RESULTS: The TLFT originated from the anterior wall of the right CCA and was divided into the superior thyroid artery and linguofacial trunk (LFT). The LFT was divided into lingual and facial arteries. In addition, we observed fusiform dilatation of the intracranial right vertebral artery, which might have caused these symptoms. CONCLUSION: The presence of a common trunk of the external carotid artery (ECA) branches increases the risk of complications such as bleeding and ischemia during treatment of the head and neck region, including chemoradiotherapy for oral bleeding and tongue cancer. Therefore, this is an area of significant interest across various medical specialties, including surgery, otolaryngology, and radiology. Understanding the diverse variations in the neck vasculature is expected to lead to a reduction in complications associated with various procedures.

Persistent trigeminal artery variant and presumed ophthalmic artery simultaneously arising from the inferolateral trunk incidentally diagnosed by magnetic resonance angiography.

PURPOSE: To describe a case of persistent trigeminal artery variant (PTAV) and presumed ophthalmic artery (OA) simultaneously arising from the inferolateral trunk (ILT). METHODS: A 53-year-old woman with an initial episode of convulsion underwent cranial magnetic resonance imaging (MRI) and MR angiography (MRA) of the intracranial region for the evaluation of brain and vascular lesions. The MR machine was a 3-T scanner. RESULTS: MRI revealed no pathological brain lesions. On MRA, the left anterior inferior cerebellar artery (AICA) arose from the cavernous segment of the internal carotid artery (ICA), indicative of the PTAV. The arising point was more distal than the usual point, and the presumed OA also arose simultaneously from the short common trunk, which was considered the ILT. CONCLUSION: There are two types of PTA: lateral (usual) and medial (intrasellar) PTA. The lateral-type PTA and PTAV arise from the ICA of the distal precavernous-proximal cavernous segment and take a course similar to that of the posterior fossa. The medial type arises slightly more in the distal cavernous segment than in the lateral type. The OA rarely arises from the cavernous segment of the ICA and enters the orbit via the superior orbital fissure. The origin of this type of OA is considered to be the ILT. We herein report a case of a PTAV and presumed OA arising simultaneously from an ILT. No similar case has been reported in the relevant English language literature.

Medial-type persistent trigeminal artery and ipsilateral posterior communicating artery supplying bilateral posterior cerebral arteries combined with an aberrant right subclavian artery and bicarotid trunk.

PURPOSE: To describe a case of a medial-type persistent trigeminal artery (PTA) associated with multiple arterial variations. METHODS: A 34-year-old woman with multiple sclerosis underwent cranial magnetic resonance (MR) angiography from the aortic arch to the neck region and intracranial region for the evaluation of an unruptured cerebral aneurysm that was previously detected on MR imaging. The MR machine was a 3-T scanner. RESULTS: There was an aberrant right subclavian artery and bicarotid trunk, medial-type left PTA and ipsilateral posterior communicating artery (PCoA) supplying bilateral posterior cerebral arteries (PCAs). The unruptured aneurysm was located at the paraclinoid segment of the left internal carotid artery and was treated successfully by coil embolization via a transfemoral approach. CONCLUSION: Only 10% of PTAs are classified as the medial type. The association with extremely large ipsilateral PCoA, which supplies the bilateral PCAs, has not been previously reported. Aberrant right subclavian arteries are common and are frequently associated with a bicarotid trunk. Before catheterization of the cerebral arteries, the aortic arch and its branches must be evaluated by MR angiography or computed tomography angiography to prevent catheterization failure via the right transradial approach.

MDCT evaluation of Dorsal Pancreatic Artery and Intrapancreatic arcade anatomy.

OBJECTIVE: The purpose of the study was to analyze the anatomy and variations in the origin of the dorsal pancreatic artery, greater pancreatic artery and to study the various types of arterial arcades supplying the pancreas on multidetector CT (MDCT). METHODS: A retrospective analysis of 747 MDCT scans was performed in patients who underwent triple phase or dual phase CT abdomen between December 2020 and October 2022. Variations in origin of Dorsal pancreatic artery (DPA), greater pancreatic artery (GPA), uncinate process branch were studied. Intrapancreatic arcade anatomy was classified according to Roman Ramos et al. into 4 types-small arcades (type I), small and large arcades (type II), large arcades (type III) and straight branches (type IV). RESULTS: The DPA was visualized in 65.3% (n = 488) of cases. The most common origin was from the splenic artery in 58.2% (n = 284) cases. The mean calibre of DPA was 2.05 mm (1.0-4.8 mm). The uncinate branch was seen in 21.7% (n = 106) with an average diameter of 1.3 mm. The greater pancreatic artery was seen in 57.3% (n = 428) predominantly seen arising from the splenic artery. The most common arcade anatomy was of Type II in 52.1% (n = 63) cases. CONCLUSION: Pancreatic arterial variations are not very uncommon in daily practice. Knowledge of these variations before pancreatic surgery and endovascular intervention procedure is important for surgeons and interventional radiologist.

Perforating and ophthalmic artery variants from the anterior cerebral artery: Two case reports.

BACKGROUND: The diagnosis and therapy during surgery depend largely on a full account of anatomic characteristics. Apart from regular structures, the common, less common or even uncommon anatomic variations are critical for procedural planning. This is especially true during craniocerebral microsurgery, where small vascular variations can affect the final surgical results and patient prognosis. CASE SUMMARY: Herein, two rare variations concerning the A1 (horizontal) segment of anterior cerebral artery (ACA1) were introduced. One enabled the communication between perforating branch of ACA1 and dural artery of anterior skull base, which was discovered during autopsy. The other was ophthalmic artery (OA) originating from ACA1, shown on digital angiography. CONCLUSION: In this study, we found two rare anatomical variations. One was an abnormal OA originated from the anterior communicating artery. The other was a perforating branch of the A1 segment of the anterior cerebral artery, which communicated with meningeal vessels in the anterior skull base. This finding is of great significance for the treatment of anterior communicating artery aneurysm or in other anterior skull base surgery.

Congenital external carotid-internal carotid artery anastomosis: a report of three cases and literature review.

PURPOSE: Congenital external carotid-internal carotid artery (EC-ICA) anastomosis is a cervical arterial variation that was initially reported, based on anatomic dissection, from Japan in 2000. The purpose of this report is to show the characteristic radiological findings of this extremely rare cervical arterial variation. METHODS: We analyzed nine cases, including six previously reported cases and three cases that we recently experienced. Three of the six previously reported cases were from Japan, and the remaining three cases were from Korea. MR angiography (4), CT angiography (2), catheter angiography (2) and autopsy (1) were used as diagnostic modalities. RESULTS: The study population included eight men and one woman. Anastomosis was seen on the left side in seven cases and the right side in two cases, and it was located at the level of the C1/2-C2/3 intervertebral space. In all cases, ECA was larger than the ICA at the level of their origins. In four cases, the ICA was extremely small in caliber. In one case, the ICA may have been occluded postnatally, and its configuration was similar to that of the nonbifurcating cervical carotid artery (CCA). With the exception of this occluded case, the carotid bifurcation and EC-ICA anastomosis formed a large arterial ring in all cases. CONCLUSION: EC-ICA anastomosis can be regarded as a variant of the nonbifurcating CCA because if the most proximal segment of the small ICA is occluded, nonbifurcating CCA may form. EC-ICA anastomosis is located between the C1/2-C2/3 intervertebral space and may be formed by the remnants of the proatlantal artery I.

A posterior inferior cerebellar artery of C2 transverse foramen level origin that entered the spinal canal via the C1/2 intervertebral space demonstrated by computed tomography angiography.

PURPOSE: To describe a case of a posterior inferior cerebellar artery (PICA) of C2 transverse foramen level vertebral artery (VA) origin that entered the spinal canal via the C1/2 intervertebral space. CASE REPORT: A 48-year-old man with posterior neck pain underwent computed tomography (CT) angiography and selective left vertebral angiography. Arterial dissection was found at the distal V2 segment of the left VA on subtracted CT angiography. The left PICA arising from the VA at the level of C2 transverse foramen was identified on CT angiography with bone imaging. This PICA of extracranial origin entered the spinal canal via the C1/2 intervertebral space, just like a PICA of C1/2 level origin. DISCUSSION: The origins of PICAs show several variations. PICAs originating at the extracranial C1/2 level VA are relatively rare, with a reported prevalence of approximately 1%. Our patient had a left PICA arising from the VA at the level of the C2 transverse foramen. No similar cases have been reported in the relevant English-language literature. We speculated that the proximal short segment of the PICA arising from the C1/2 level VA regressed incidentally and that the distal segment of the PICA was supplied by the muscular branch of the VA arising from the level of the C2 transverse foramen. CONCLUSION: We reported the first case of PICA arising from the C2 transverse foramen level VA. CT angiography with bone imaging is useful for identifying a PICA arising from the extracranial VA.

Arterial abnormalities and associated variations of the vertebrobasilar system on the brain base: apropos of a rare case / Anomalías arteriales y variaciones asociadas del sistema vertebrobasilar en la base del cerebro: un caso raro

SUMMARY: The presented case characterizes an association of primitive and definitive arteries with variations on the cadaveric brain base of a very old man. This case is found by the retrospective review of the data archive obtained during many years of cooperation of the author and co-authors. Fenestration of the (ectatic) basilar artery, partial and total duplication of some cerebellar arteries was associated with other variations of the vertebrobasilar and carotid systems. Although this is a case autopsied because of the myocardial infarction, the peculiarity of the case lies in the absence of the aneurysm based on the fenestration or dissection of one of the cerebral arteries.

RESUMEN: El caso presentado caracteriza una asociación de arterias primitivas y definitivas con variaciones sobre la base cerebral cadavérica de un anciano. Este caso se encuentra mediante la revisión retrospectiva de datos obtenidos durante muchos años de un trabajo de cooperación del autor y coautores. La fenestración de la arteria basilar (ectásica), la duplicación parcial y total de algunas arterias cerebelosas se asoció con otras variaciones de los sistemas vertebrobasilar y carotídeo. Si bien se trata de un caso de autopsia a causa de un infarto del miocardio, la peculiaridad del caso radica en la ausencia del aneurisma en base a la fenestración o disección de una de las arterias cerebrales.

Embryology of the anterior communicating artery complex: implications on possible adult variants.

The anterior cerebral artery (ACA) and the anterior communicating artery (AComA) are important arteries of the telencephalon and are prominent location for cerebral aneurysms. Their embryological development is closely linked, and explains the possible variants seen in adults. In this paper, we present details related to the development of these two arteries, focusing on some variants such as the infra-optic course of the ACA, the unpaired ACA, and the persistent primitive olfactory artery.

Variations in the Pattern of the Deep Palmar Arch of the Hand and Its Surgical Importance.

Background The deep palmar arch is formed by anastomosis of the continuation of the radial artery with the deep palmar branch of the ulnar artery. With recent advances in microsurgical techniques for vascular repair, the knowledge of variations in the arteries of the hand, as well as the caliber of these arteries, has become more important for surgeons. Additionally, radial artery harvesting for myocardial revascularization is being performed nowadays, for which collateral circulation in the hand through the palmar arches is a prerequisite. Therefore, this study was conducted to study the patterns of the deep palmar arch and perform the morphometry of the arch. Methodology In this study, 30 hands (16 right and 14 left) from formalin-fixed adult human cadavers were dissected to observe the completeness, formation, and branching pattern of the deep palmar arch. The length of the arch was measured using a thread and scale. The diameters of the forming arteries and branches of the arch were measured at their origin using a digital vernier caliper. Results All deep palmar arches were complete. The arches were classified into two types based on whether the superior or inferior deep palmar branch of the ulnar artery completed the arch. Another classification was based on the interosseous space through which the radial artery or its branch entered the palmar region to complete the deep palmar arch. The length of the arch was 4.2 ± 0.47 cm on the right side and 4.0 ± 0.6 cm on the left side. The diameters of the deep palmar branch of the radial and ulnar arteries at their origin were 4.02 ± 0.48 mm and 1.90 ± 0.36 mm, respectively. No significant difference was found between the right and left sides. Conclusions The anastomosis was found between radial and ulnar arteries in all cases of the deep palmar arch. Therefore, it can be safe to sacrifice the radial artery in procedures such as radial artery harvesting and radial artery flap transfer. The knowledge of variations and morphometry of the arch will facilitate vascular repair surgeries on hands.

Arteries of the Lower Limb-Embryology, Variations, and Clinical Significance.

OBJECTIVES: The purpose of this article is to review the embryology of the lower limb arterial anatomy along with common variants and their clinical relevance. DESIGN: Embryologic variations of the lower limb arterial system may be explained by i.) persistence of primordial arterial segments, ii.) abnormal fusion, iii.) segmental hypoplasia/absence, or a combination of both. Persistent sciatic artery, corona mortis, and popliteal entrapment syndrome will also be discussed with associated symptoms, and potential complications. CONCLUSION: Knowledge of these variations is essential for surgical and endovascular management as failure to recognize them can result in complications.

Double unilateral fenestration of the anterior cerebral artery in the pre-communicating segment: a report of a unique case.

A unique example of two fenestrations of the pre-communicating (A1) segment of the right anterior cerebral artery (ACA) in a 78-year-old woman was a special case among 388 cadaveric specimens. It was found by a retrospective review of the personal data obtained during graduate and undergraduate studies at the Faculty of Medicine. Two unequal fenestrations of the right A1 segment were associated with the presence of a pseudo anterior communicating artery, hypoplasia of the right posterior communicating artery and the left superior cerebellar artery, absence of the right anterior inferior cerebellar artery, and ectasia of the basilar artery; however, the cerebral arteries were without aneurysm(s) or other pathology. The reason could be the almost equal ACA diameter on both sides.

Anatomic mapping of the collateral branches of the external carotid artery with regard to daily clinical practice.

BACKGROUND: To identify the anatomical variations of the main branches of the external carotid artery (lingual, facial, occipital, ascending pharyngeal and sternocleidomastoid), giving information about the calibers and origins with the aim of creating a new classification useful in clinical practice. MATERIAL AND METHODS: 193 human embalmed body-donors were dissected. The data collected were analyzed using the Chi² test. The results of previous studies were reviewed. RESULTS: The majority of the anterior arterial branches (superior thyroid, facial and lingual artery) were observed with an independent origin, respectively, classified as pattern I (80.83%, 156/193). In 17.62% (34/193) a linguofacial trunk, pattern II, has been observed, only in 1,04% (2/193) a thyrolingual trunk, pattern III, has been found and in one case (1/193, 0.52%) one thyrolinguofacial trunk, pattern IV, was found. Depending on the posterior branches (occipital and ascending pharyngeal), four different types could be determined: type a, the posterior arteries originated independently, type b, the posterior arteries originated in a common trunk, type c, the ascending pharyngeal artery was absent, type d, the occipital artery was absent. CONCLUSION: Anatomical variations in these arteries are relevant in daily clinical practice due to growing applications, e.g., in Interventional Radiology techniques. Knowledge of these anatomical references could help clinicians in the interpretation of the carotid system.

Variant Arterial Supply of the Descending Colon by the Coeliac Trunk: A Case Report.

Background and Objectives: Knowledge of arterial variations of the intestines is of great importance in visceral surgery and interventional radiology. Materials and Methods: An unusual variation in the blood supply of the descending colon was observed in a Caucasian female body donor. Results: In this case, the left colic artery that regularly derives from the inferior mesenteric artery supplying the descending colon was instead a branch of the common hepatic artery. Conclusions: Here, we describe the very rare case of an aberrant left colic artery arising from the common hepatic artery in a dissection study.

Embryology and variations of the recurrent artery of Heubner.

PURPOSE: The recurrent artery of Heubner (RAH) is a very fascinating artery for various reasons. The first one is its early development in the embryologic and phylogenic life. The second one is the discrepancy between its diameter and its functional importance and the last but not least reason is the many variations of origin and course of this artery. METHODS: For more than a century, numerous studies furnished important information about variations in origin, course, and parenchymal territory of the RAH. The most important anomaly concerning the RAH is the accessory middle cerebral artery and well-illustrates the complexity of its embryologic development. CONCLUSION: For these reasons, authors provide a review of anatomical variations of this artery that could be encountered with a particular attention given to the history and embryological knowledge.

Embryology and anatomical variations of the ophthalmic artery.

PURPOSE: The ophthalmic artery (OA) has one of the most complex anatomy and the most fascinating embryological development. METHODS: The complexity of the embryologic development of the OA resides in the implication of three different embryological systems: the carotid system, the stapedial system, and the ventral pharyngeal system. RESULTS: This explains very well the numerous variations in origin of the OA and the importance of vascular anastomoses developed with branches of the external carotid artery and with the middle meningeal artery. CONCLUSION: In this review, authors propose a comprehensive description of different hypotheses on the embryologic development of the OA and, in a second part, explain all anatomical variations and clinical implications of this artery.

Carotid-vertebrobasilar anastomosis: magnetic resonance and computed tomographic angiographic demonstration.

Carotid-vertebrobasilar (VB) anastomoses are rare and usually found incidentally, but they can have clinical significance. Their variance can represent aneurysm formation at the origin of the anomalous artery, cerebral ischemia due to unique blood flow, or other complications. Thus, recognition and correct diagnosis of these anomalous vessels are important when interpreting magnetic resonance (MR) and computed tomography (CT) angiography. This pictorial essay presents MR and CT angiographic images of several types of persistent fetal carotid-VB anastomoses, including those involving the proatlantal, hypoglossal, and trigeminal arteries as well as their variants. Images depict types 1 and 2 proatlantal arteries, persistent second cervical intersegmental artery, persistent hypoglossal artery (PHA), PHA of external carotid origin, two types of the PHA variant, posterior inferior cerebellar artery arising from the jugular branch of the ascending pharyngeal artery, lateral and medial types of persistent trigeminal arteries (PTAs), and four types of PTA variants.

Variant hepatic arterial anatomy encountered during pancreatoduodenectomy does not influence postoperative outcomes or resection margin status: A matched pair analysis of 105 patients.

BACKGROUND/AIM: Anatomic vascular abnormalities of the hepatic arteries are frequent. The aim of the study was to analyze the influence of hepatic arterial variations on postoperative morbidity and resection margin status after pancreatoduodenectomy (PD). MATERIALS/METHODS: Patients who underwent PD over a 7-year period (2010-2017) were included in the study. Patients with variant hepatic arterial anatomy were matched 1:2 for age, sex, ASA score, and histology. RESULTS: A total of 232 patients underwent PD. Variant hepatic arterial anatomy was found in 35 (15.1% of the total patient population). The most common variation was an accessory right hepatic artery (8.19%) and a replaced right hepatic artery (5.60%) arising from the superior mesenteric artery. These 35 patients were compared with 70 patients with no hepatic artery variations. Postoperative surgical complications occurred in 12.1% and 26.5% (P = 0.08) and in-hospital mortality was 6% and 5.4% ( P = 0.99) between patients with and without variant hepatic arteries. There was no difference in positive resection margins (R1) (18.2% vs 20.5%, P = 0.99) between the two groups. CONCLUSIONS: An aberrant hepatic artery does not increase morbidity or R1 resection in patients undergoing PD.

Anatomy of the Le Fort I segment: Are arterial variations a potential risk factor for avascular bone necrosis in Le Fort I osteotomies?

PURPOSE: Osteotomies of the Le Fort I segment are routine operations with low complication rates. Ischemic complications are rare, but can have severe consequences that may lead to avascular bone necrosis of the Le Fort I segment. Therefore the aim of this study was to investigate the blood supply and special arterial variants of the Le Fort I segment responsible for arterial hypoperfusion or ischemic avascular necrosis after surgery. MATERIAL AND METHODS: The arterial anatomy of the Le Fort I segment's blood supply using 30 halved human cadaver head specimens was analyzed after complete dissection until the submicroscopic level. In all specimens the arterial variants of the Le Fort I segment and also the arterial diameters measured at two points were evaluated. RESULTS: The typical known vascularization pattern was apparent in 90% of all specimens, in which the ascending palatine (D1: 1,2 mm ± 0,34 mm; D2: 0,8 mm ± 0,34 mm) and ascending pharyngeal artery (D1: 1,3 mm ± 0,58 mm; D2: <0,4 mm) were both supplying the Le Fort I segment. However in 10% of all specimens, the Le Fort I segment was dependent on the ascending pharyngeal artery alone and the missing ascending palatine artery was replaced with the anterior branch of the ascending pharyngeal artery (D1: 1,9 mm ± 0,32; D2: 1,0 mm ± 0,3 mm). CONCLUSION: This study is the first description of a special type of arterial variation of the Le Fort I segment. The type of this arterial variation, its clinical relevance and potential consequences are explained. Individuals with this special arterial anatomy may clinically be at a high risk for hypoperfusion and avascular segment necrosis after surgery. An individualized operation plan may prevent ischemic complications in at-risk patients.