Estudio de la prevalencia del nacimiento y de la presencia de bucle caudal extracraneano de arterias cerebelosas posteroinferiores en una población estudiada por angiografía cerebral / Study of the prevalence of origin and the presence of an extracranial caudal loop of the posterior inferior cerebellar arteries in a population studied by cerebral angiography

Introducción. La arteria cerebelosa posteroinferior (ACPI) nace de la arteria vertebral en la cara anterolateral del tronco cerebral, generalmente a la altura de la oliva inferior, transcurriendo en forma rostral a través de las raíces de los nervios glosofaríngeo, vago y accesorio. El objetivo del trabajo es determinar la prevalencia del nacimiento de la arteria cerebelosa postero inferior a nivel extracraneano, la presencia de bucle caudal extracraneano y las relaciones con estructuras oseas adyacentes, en una población estudiada por angiografía de vasos supraaórticos. Material y métodos. Estudio prospectivo, descriptivo, de una muestra consecutiva realizada durante un año (septiembre 2021 a agosto 2022) de todos los pacientes a los que se les realizó un cateterismo de vasos de cuello y cerebrales en Neurointervencionismo del Hospital de Alta Complejidad en Red "El Cruce", Buenos Aires, Argentina.Los estudios se realizaron en dos angiógrafos digitales en forma indistinta en incidencia perfil, con y sin digitalización de imagen, focalizadas en la unión craneo-cervical en todos los pacientes estudiados entre 18 y 80 años. Se objetivó el lugar de nacimiento de las arterias ACPI y la presencia de bucles extracraneanos por visión directa en los estudios sin y con sustracción. Se definió como bucle o loop extracraneano a la presencia de un segmento curvo de la arteria con dirección caudal que se extiende por debajo del foramen magno. Se buscó la concordancia interobservador entre 2 profesionales en forma independiente. Resultados. De los 404 procedimientos realizados en el período estudiado ingresaron 288 pacientes al estudio, de los cuales 152 fueron mujeres. La edad promedio fue de 49,2 años. Se analizaron 422 ACPI, 214 derechas y 208 izquierdas. Se observaron un total de 102 ACPI con bucles extracraneanos, representando un 24,1% del total: 49 derechos (48%) y 53 izquierdos (52%). En relación a arterias con origen extracraneal, se observaron en total 58 (13,7%) de las cuales 29 fueron derechas (50%). En 10 casos se observó en la misma arteria nacimiento y loop extracraneano (10%) y en dos casos nacimiento y loop extracraneano bilateral (3.9%). En 13 casos la arteria vertebral fue terminal en ACPI, de las cuales 5 presentaron un loop extracraneano, representando el 38,5 % de su población, siendo en su totalidad del territorio derecho. Conclusión. La prevalencia del nacimiento extracraneano de la ACPI en la población estudiada por angiografía fue de 13,7% y la prevalencia de bucle extracraneano fue del 24%. Ambos porcentajes se encuentran dentro de los resultados hallados en estudios previos, anatómicos y por imágenes: 0,7 al 20% y 9,5 al 35% respectivamente. La prevalencia de bucle extracraneano en arterias vertebrales con terminación en ACPI fue del 38,5%, siendo significativamente superior a los estudios reportados

Background. The posteroinferior cerebellar artery (PICA) arises from the vertebral artery on the anterolateral aspect of the brain stem, generally at the level of the inferior olive, running rostrally through the roots of the glossopharyngeal, vagus and accessory nerves. The objective of the work is to determine the prevalence of the origin of the posterior inferior cerebellar artery at the extracranial level, the presence of an extracranial caudal loop and the relationships with adjacent bone structures, in a population studied by angiography of supra-aortic vessels. Methods. Prospective, descriptive study of a consecutive sample carried out for one year (September 2021 to August 2022) of all patients who underwent catheterization of neck and cerebral vessels in the "Hospital de Alta Complejidad en Red El Cruce", Buenos Aires, Argentina. The studies were carried out in two digital angiographers indistinctly in profile incidence, with and without image digitization, focused on the cranio-cervical junction in all patients studied between 18 and 80 years of age. The birthplace of the ACPI arteries and the presence of extracranial loops were observed by direct vision in the studies without and with subtraction. An extracranial loop was defined as the presence of a curved segment of the artery with a caudal direction that extends below the foramen magnum. Interobserver agreement was sought between 2 professionals independently. Results. Of the 404 procedures performed in the studied period, 288 patients entered the study, of which 152 were women. The average age was 49,2 years; 422 PICA were analyzed, 214 right and 208 left. A total of 102 PICA with extracranial loops were observed, representing 24.1% of the total: 49 right (48%) and 53 left (52%). In relation to arteries with extracranial origin, a total of 58 (13.7%) were observed, of which 29 were right (50%). In 10 cases birth and extracranial loop were observed in the same artery (10%) and in two cases birth and bilateral extracranial loop (3.9%). In 13 cases the vertebral artery was terminal in PICA, of which 5 presented an extracranial loop, representing 38.5% of its population, being entirely in the right territory. Conclusions. The prevalence of extracranial origin of the PICA in the population studied by angiography was 13.7% and the prevalence of extracranial loop was 24%. Both percentages are within the results found in previous anatomical and imaging studies: 0.7 to 20% and 9.5 to 35% respectively. The prevalence of extracranial loop in vertebral arteries ending in PICA was 38.5%, being significantly higher than the reported studies

Variaciones anatómicas en la vascularización del colon derecho y su implicancia en la escisión completa del mesocolon con linfadenectomía D3. Estudio de corte transversal / Anatomical variations in right colon vascularization: its implication in complete mesocolic excision with D3 lymphadenectomy. A cross-sectional study

Introducción: La escisión completa del mesocolon con linfadenectomía D3 (CME-D3) mejora los resultados de los pacientes operados por cáncer del colon. Reconocer adecuadamente la anatomía vascular es fundamental para evitar complicaciones. Objetivo: El objetivo primario fue determinar la prevalencia de las variaciones anatómicas de la arteria mesentérica superior (AMS) y sus ramas en relación a la vena mesentérica superior (VMS). El objetivo secundario fue evaluar la asociación entre las distintas variantes anatómicas y el sexo y la etnia de lo pacientes. Diseño: Estudio de corte transversal. Material y métodos: Se incluyeron 225 pacientes con cáncer del colon derecho diagnosticados entre enero 2017 y diciembre de 2020. Dos radiólogos independientes describieron la anatomía vascular observada en las tomografías computadas. Según la relación de las ramas de la AMS con la VMS, la población fue dividida en 2 grupos y subdividida en 6 (1a-c, 2a-c). Resultados: La arteria ileocólica fue constante, transcurriendo en el 58,7% de los casos por la cara posterior de la VMS. La arteria cólica derecha, presente en el 39,6% de los pacientes, cruzó la VMS por su cara anterior en el 95,5% de los casos. La variante de subgrupo más frecuente fue la 2a seguida por la 1a (36,4 y 24%, respectivamente). No se encontró asociación entre las variantes anatómicas y el sexo u origen étnico. Conclusión: Las variaciones anatómicas de la AMS y sus ramas son frecuentes y no presentan un patrón predominante. No hubo asociación entre las mismas y el sexo u origen étnico en nuestra cohorte. El reconocimiento preoperatorio de estas variantes mediante angiotomografía resulta útil para evitar lesiones vasculares durante la CME-D3. (AU)

Background: Complete mesocolic excision with D3 lymphadenectomy (CME-D3) improves the outcomes of patients operated on for colon cancer. Proper recognition of vascular anatomy is essential to avoid complications. Aim: Primary outcome was to determine the prevalence of anatomical variations of the superior mesenteric artery (SMA) and its branches in relation to the superior mesenteric vein (SMV). Secondary outcome was to evaluate the association between these anatomical variations and sex and ethnicity of the patients. Design: Cross-sectional study. Material and methods: Two hundred twenty-fivepatients with right colon cancer diagnosed between January 2017 and December 2020 were included. Two independent radiologists described the vascular anatomy of computed tomography scans. The population was divided into 2 groups and subdivided into 6 groups (1a-c, 2a-c), according to the relationship of the SMA and its branches with the SMV. Results: The ileocolic artery was constant, crossing the SMV posteriorly in 58.7% of the cases. The right colic artery, present in 39.6% of the patients, crossed the SMV on its anterior aspect in 95.5% of the cases. The most frequent subgroup variant was 2a followed by 1a (36.4 and 24%, respectively). No association was found between anatomical variants and gender or ethnic origin. Conclusions: The anatomical variations of the SMA and its branches are common, with no predominant pattern. There was no association between anatomical variations and gender or ethnic origin in our cohort. Preoperative evaluation of these variations by computed tomography angi-ography is useful to avoid vascular injuries during CME-D3. (AU)

Evaluación angiográfica de la distribución anatómica de la irrigación sanguínea del ángulo esplénico del colon en población chilena

Objetivo: Identificar los patrones de distribución vascular del ángulo esplénico del colon (AEC) en la población chilena para su comparación con la literatura oriental (Fukuoka). Materiales y Métodos: Estudio descriptivo, transversal. Se caracterizó la irrigación del AEC de imágenes con protocolo Urotac realizadas en Clínica INDISA entre el año 2020 y 2021 (n = 127), clasificándolas dentro de 6 tipos descritos por Fukuoka. Se evaluaron características demográficas y comorbilidades. Las variables fueron analizadas utilizando estadística descriptiva y la significancia mediante la prueba Chi2. Resultados: Existen diferencias en los tipos irrigación del AEC entre la serie local y Fukuoka, la irrigación tipo 3 fue la que presentó mayor variación (p < 0,05). El tipo 1 es la más frecuente (34,7%), sin casos del Tipo 4. No se identificó diferencia entre los distintos tipos de irrigación con relación a las variables demográficas y comorbilidades. Discusión: Al comparar nuestra serie con la oriental se evidenció similar frecuencia en tipos 1 y 6, mayor en tipos 3 y 5, y tipos 2 y 4 con menor representación. Se identificó un mayor aporte en la irrigación del AEC por la arteria cólica izquierda (ACI) en la población estudiada (64,6%). Conclusión: Nuestra población tiene mayor participación de ACI en irrigación del AEC que orientales (64,6% vs 49,6%), los tipos más frecuentes son 1, 3 y 6, el Tipo 1 es la forma más frecuente de irrigación, similar a Fukuoka (34,7% vs 39,7%), Tipo 3 tiene mayor representación en nuestra población que en la oriental (29,9% vs 9,9%).

Objective: To identify the vascular distribution patterns of the splenic flexure of the colon (AEC) in the Chilean population for comparison with the oriental literature (Fukuoka). Methods: Descriptive, cross-sectional study. The irrigation of the AEC of images with the Urotac protocol performed at the INDISA Clinic between 2020 and 2021 (n = 127) was characterized, classifying them into 6 types described by Fukuoka. Demographic characteristics and comorbidities were evaluated. Variables were analyzed using descriptive statistics and significance using the Chi2 test. Results: There are differences in the types of irrigation of the AEC between the local series and Fukuoka, irrigation type 3 was the one that presented the greatest variation (p < 0.05). Type 1 is the most frequent (34.7%), with no cases of Type 4. No difference was identified between the different types of irrigation in relation to demographic variables and comorbidities. Discussion: When comparing our series with the eastern one, a similar frequency was found in types 1 and 6, higher in types 3 and 5, and types 2 and 4 with less representation. A greater contribution was identified in the irrigation of the AEC by the left colic artery (ICA) in the population studied (64.6%). Conclusion: Our population has a greater participation of ICA in AEC irrigation than Orientals (64.6% vs 49.6%), the most frequent types are 1, 3 and 6, Type 1 is the most frequent form of irrigation, similar to Fukuoka (34.7% vs 39.7%), Type 3 is more represented in our population than in the eastern one (29.9% vs 9.9%).

Craniovascular variation in four late Holocene human samples from southern South America.

Craniovascular traits in the endocranium (traces of middle meningeal vessels and dural venous sinuses, emissary foramina) provide evidence of vascular anatomy in osteological samples. We investigate the craniovascular variation in four South American samples and the effect of artificial cranial modifications (ACM). CT scans of human adult crania from four archeological samples from southern South America (including skulls with ACM) are used for the analyses. The craniovascular features in the four samples are described, skulls with and without ACM are compared, and additionally, South Americans are compared to a previously analyzed sample of Europeans. Of the four South American samples, the Southern Patagonian differs the most, showing the most distinct cranial dimensions, no ACM, and larger diameters of the emissary foramina. Unlike previous studies, we did not find any major differences in craniovascular features between modified and non-modified skulls, except that the skulls with ACM present somewhat smaller foramina. South Americans significantly differed from Europeans, especially in the anteroposterior dominance of the middle meningeal artery, in the pattern of sinus confluence, in the occurrence of enlarged occipito-marginal sinuses, and in foramina frequencies and diameters. Craniovascular morphology is not affected by the cranial size, even in skulls with ACM, indicating a minor or null influence of structural topological factors. Concerning the samples from distinct geographic and climatic environments, it must be evaluated whether the craniovascular morphogenesis might be partially influenced by specific functions possibly associated with thermoregulation, intracranial pressure, and the maintenance of intracranial homeostasis.

Avoiding vascular complications in insular glioma surgery - A microsurgical anatomy study and critical reflections regarding intraoperative findings.

Introduction: Vascular lesions in insular glioma surgery can severely impact patients' quality of life. This study aims to present the results of our dissections and authors' reflections on the insular vascular anatomy. Matherials and Methods: The insular vascularization was examined using ×3 to ×40 magnification in 20 cadaveric cerebral hemispheres in which the arteries and veins had been perfused with colored silicone. Results: In insular gliomas, this individualization of the anatomical structures is rarely possible, as the gyri are swollen by the tumor and lose their individuality. In the transsylvian approaches, the anatomical parameters for delimiting the insula in tumors are best provided by the superior and inferior circular sulci. The branches of the MCA are easily identified in the transcortical approach, but only at the end of the surgery after the tumor is resected.). One of the factors under-discussed in the literature is the involvement of the lenticulostriate arteries by the medial part of the tumor. In our experience of 52 patients (article submitted to publishing), LSTa were founded to be involved by the tumor in 13 cases. In 39 patients, there was no involvement of the LSTa, which allowed a more aggressive resection. Early preoperative identification of the anterior perforated substance on the MRI and its proximity to the tumor may help determine the route of the LSTa over the medial tumor boundaries. Discussion: Our reflections introduced our imaging and anatomical concept regarding LSTa in insular glioma surgery. Accurate identification of origin, route, and distribution of the LSTa is pivotal to surgical success, especially in the lateral group. The anatomical knowledge of their path directly impacts the extent of tumor resection and functional preservation. Conclusion: Knowledge of microsurgical anatomy, brain mapping, and surgical experience counts a lot in this type of surgery, creating a reasonable procedure flowchart to be taken intraoperatively.

Tibial plateau leveling osteotomy in dogs: an ex vivo comparative study of knee's surrounding structures protection methods

Background: Cranial cruciate ligament failure is one of the leading causes of pelvic limb lameness in dogs and one of the most recommended treatments is tibial plateau leveling osteotomy (TPLO) surgery. However, this procedure may lead to some complications as fractures of the fibula, laceration in varying degrees of the popliteal vasculature and its branches, neuropraxia, neurotmeses, among others. The goals of this study were to compare the effectiveness of 8 methods used during TPLO, to prevent damage to the cranial tibial artery, fibula, tibial and fibular nerve (surgical compresses, specific surgical retractors I and II and an osteotomy technique variation). Materials, Methods & Results: A total of 40 canine cadavers weighing 25.9 ± 3.7 kg were submitted to TPLO. Animals were previously prepared with 1: 4 barium red latex solution, to provide radiopacity of arteries surrounding the knee (n = 80). TPLO was performed using 8 methods to protect the cranial tibial artery, fibula, and tibial and fibular nerves. Each method was used in one of the knees of 5 animals. The contralateral knee was maintained as a control (without protection). The knees were radiographed in orthogonal projections before and after the osteotomies and then anatomically dissected. The evaluated structures were photographed, and the images sent to four blind evaluators (visual macroscopy) to classify the possible injuries. The highest incidence of injuries was identified when protection methods were used. However, this difference was not significant (P > 0.05). No significant differences regarding efficacy were found between all 8 protection methods. Discussion: In this study, the total incidence of injuries following TPLO was 20% was much higher than that presented in the literature which indicates when considering only intraoperative injuries. The dogs cadavers tissue resistance and stiffened latex may have predisposed the osteotomy injury, as soft tissues with greater flexibility are less susceptible to trauma caused by the oscillatory saw. When compared to others cadaveric studies that also evaluated the efficacy of surgical dressings to protect the cranial tibial artery, during TPLO, we also find a higher incidence of damage. Maybe the limb's position was responsible for this difference, once in the after mentioned researches the limb was positioned suspended to simulate a dorsal decubitus position and we choose the limb position with the lateral face resting on the surface of the operating table, and this may have provided extra pressure from the structures towards the osteotomy saw, increasing the occurrence of those damages. Although the present study did not reveal a significant difference for the use of protection methods, we believe that the dimensions of the compresses used herein may have contributed to a higher incidence of injuries. They probably increased the tissue trauma needed for their allocation and led to a lower positioning accuracy for the isolation of these structures. Maybe for the same reason, the specific type II surgical retractor was the only shield that, observationally, did not increase the occurrence of injuries, once less dissection was required to allocate it. The difference in geometric dimensions between the retractors may justify the superiority of the retractor II, since it allows a more careful and apparently less traumatic allocation. Performing TPLO without adopting these protection methods did not lead to a higher risk of injury to the cranial tibial artery, fibula, and tibial and fibular nerves.

Advanced image guidance for prostatic artery embolization - a multicenter technical note.

BACKGROUND: Prostatic artery embolization (PAE) is associated with patients' quality of life improvements and limited side effects compared to surgery. However, this procedure remains technically challenging due to complex vasculature, anatomical variations and small arteries, inducing long procedure times and high radiation exposure levels both to patients and medical staff. Moreover, the risk of non-target embolization can lead to relevant complications. In this context, advanced imaging can constitute a solid ally to address these challenges and deliver good clinical outcomes at acceptable radiation levels. MAIN TEXT: This technical note aims to share the consolidated experience of four institutions detailing their optimized workflow using advanced image guidance, discussing variants, and sharing their best practices to reach a consensus standardized imaging workflow for PAE procedure, as well as pre and post-operative imaging. CONCLUSIONS: This technical note puts forth a consensus optimized imaging workflow and best practices, with the hope of helping drive adoption of the procedure, deliver good clinical outcomes, and minimize radiation dose levels and contrast media injections while making PAE procedures shorter and safer.

Relationship Between the Middle Genicular Artery and the Posterior Structures of the Knee: A Cadaveric Study.

BACKGROUND: The middle genicular artery (MGA) is responsible for the blood supply to the cruciate ligaments and synovial tissue. Traumatic sports injuries and surgical procedures (open and arthroscopic) can cause vascular damage. Little attention has been devoted to establish safe parameters for the MGA. PURPOSE: To investigate the anatomy of the MGA and its relation to the posterior structures of the knees, mainly the posterior capsule and femoral condyles, and to establish safe parameters to avoid harming the MGA. STUDY DESIGN: Descriptive laboratory study. METHODS: Dissection of the MGA was performed in 16 fresh, unpaired adult human cadaveric knees with no macroscopic degenerative or traumatic changes and no previous surgeries. The specimens were meticulously evaluated with emphasis on preservation of the MGA. The distances from the MGA to the medial and lateral femoral condyles were measured. The Mann-Whitney test was used for statistical analysis. RESULTS: In all specimens, the MGA emerged from the anterior aspect of the popliteal artery, distal to the superior genicular arteries, and had a short distal trajectory toward the posterior capsule where it entered proximal to the oblique popliteal ligament. The artery lay in the midportion between the condyles. The distance between the posterior aspect of the tibia and the point of entry of the MGA into the posterior joint capsule was 23.8 ± 7.3 mm (range, 14.72-35.68 mm). There was no correlation between an individual's height and the distance of the entrance point of the MGA into the posterior joint capsule to the posterior superior corner of the tibia. CONCLUSION: The middle genicular artery lies in the midportion between the medial and lateral femoral condyles. CLINICAL RELEVANCE: This knowledge is important for the preservation of the blood supply during posterior knee surgical procedures and to settle a secure distance between the posterior aspect of the tibia and the MGA input. This could decrease and prevent iatrogenic vascular injury risk to the MGA.

Unusual branching pattern of external iliac artery: case report / Patrón inusual de ramificación de la arteria ilíaca externa: reporte de caso

During the routine dissection, a rare anomaly was observed in left lower limb of a female cadaver. The external iliac artery continued as femoral artery, branched on lateral side as the lateral circumflex femoral artery and on medial side as profunda femoris artery. On tracing the lateral circumflex femoral artery, the ascending branch towards the spinous anastomosis was very thin and coursed behind the rectus femoris muscle. The transverse and descending branches were not observed, however, the artery coursed along the vastus lateralis towards the knee. The femoral artery had its normal course and continued as popliteal artery. The profunda femoris artery originated from the medial side of the external iliac artery, initially superficial to the femoral vein, coursed downwards and posteriorly, relating posteromedial to femoral artery. The medial circumflex femoral artery originated as thin branch, which further divided into two divisions. The profunda femoris gave origin of 3 perforators and continued as 4th perforator. The unusual branching pattern was observed to be novel and not reported in the literature.

Durante una disección de rutina, se observó una rara anomalía en el miembro inferior izquierdo de un cadáver de sexo femenino. La arteria ilíaca externa dio origen en el lado lateral ala arteria circunfleja femoral lateral y en el lado medial a la arteria femoral profunda. En el recorrido de la arteria circunfleja femoral lateral, la rama ascendente era muy delgada y corría detrás del músculo recto femoral. No se observaron ramas transversales y descendente, sin embargo, la arteria descendió hacia la rodilla a lo largo del músculo vasto lateral. La arteria femoral tuvo su curso normal y continuó como arteria poplítea. La arteria femoral profunda, inicialmente superficial a la vena femoral, se dirigió inferior y posteriormente colocándose posteromedial a la arteria femoral. La arteria circunfleja femoral medial se originó como una rama delgada, que otorgó dos arterias. La arteria femoral profunda dio origen a tres ramas perforantes y continuó como cuarta perforante. Este patrón de ramificación inusual es una descripción nueva no reportada en la literatura.

Anatomical features and clinical relevance of a persistent trigeminal artery.

BACKGROUND: Although persistent trigeminal artery (PTA) is uncommonly identified, knowledge of this structure is essential for clinicians who interpret cranial imaging, perform invasive studies of the cerebral vasculature, and operate this region. METHODS: A review of the medical literature using standard search engines was performed to locate articles regarding the PTA, with special attention with anatomical descriptions. RESULTS: Although anatomical reports of PTA anatomy are very scarce, those were analyzed to describe in detail the current knowledge about its anatomical relationships and variants. Additionally, the embryology, classification, clinical implications, and imaging modalities of this vessel are extensively discussed. CONCLUSIONS: Through a comprehensive review of isolated reports of the PTA, the clinician can better understand and treat patients with such an anatomical derailment.

Right retroesophageal subclavian artery

PURPOSE: The subclavian arteries can vary on their origin, course or length. One of the most common anatomical variations is the right subclavian artery originating as the last branch of the aortic arch. This artery is known as a retroesophageal right subclavian artery or "lusory artery". The right retroesophageal subclavian artery usually is described as not producing symptoms, being most discoveries coincidental. Nevertheless, it may be the site of formation of atherosclerotic plaque, inflammatory lesions or aneurysm. CASE REPORT: The present study describes a case of right retroesophageal subclavian artery and discusses the findings according to their clinical and surgical implications. CONCLUSION: The anatomic and morphologic variations of the aortic arch and its branches are significant for diagnostic and surgical procedures in the thorax and neck. If a right retroesophageal subclavian artery is diagnosed during aortic arch repair, corrective surgery should be considered. Intensive care patients should be screened before long term placement of nasogastic tube, in order to avoid fistulization and fatal hemorrhage.

OBJETIVO: A artéria subclávia pode ser variável em sua origem, trajeto e/ou comprimento. Uma das variações anatômicas mais comuns é a origem da artéria subclávia direita como o último ramo do arco aórtico. Essa artéria é conhecida como artéria subclávia retroesofágica ou "artéria lusória". A artéria subclávia direita retroesofágica é comumente descrita como assintomática, sendo os achados, na maioria das vezes, acidentais. Entretanto, essa artéria pode ser um sítio de formação de placas ateromatosas, lesões inflamatórias ou até aneurismas. RELATO DE CASO: O presente estudo descreve um caso de artéria subclávia direita retroesofágica e discute os achados de acordo com sua importância clínica e implicações cirúrgicas. CONCLUSÃO: Variações anatômicas do arco aórtico e seus ramos são significantes para diagnósticos e procedimentos cirúrgicos do pescoço e do tórax. Caso uma artéria subclávia direita retroesofágica seja diagnosticada durante uma cirurgia do arco aórtico, um procedimento corretivo deve ser considerado. Pacientes em terapia intensiva devem ser investigados para a presença dessa variação anatômica antes de uma sondagem nasogástica de longa duração para se evitar complicações como fístulas e hemorragia.

Right retroesophageal subclavian artery

PURPOSE: The subclavian arteries can vary on their origin, course or length. One of the most common anatomical variations is the right subclavian artery originating as the last branch of the aortic arch. This artery is known as a retroesophageal right subclavian artery or "lusory artery". The right retroesophageal subclavian artery usually is described as not producing symptoms, being most discoveries coincidental. Nevertheless, it may be the site of formation of atherosclerotic plaque, inflammatory lesions or aneurysm. CASE REPORT: The present study describes a case of right retroesophageal subclavian artery and discusses the findings according to their clinical and surgical implications. CONCLUSION: The anatomic and morphologic variations of the aortic arch and its branches are significant for diagnostic and surgical procedures in the thorax and neck. If a right retroesophageal subclavian artery is diagnosed during aortic arch repair, corrective surgery should be considered. Intensive care patients should be screened before long term placement of nasogastic tube, in order to avoid fistulization and fatal hemorrhage.

OBJETIVO: A artéria subclávia pode ser variável em sua origem, trajeto e/ou comprimento. Uma das variações anatômicas mais comuns é a origem da artéria subclávia direita como o último ramo do arco aórtico. Essa artéria é conhecida como artéria subclávia retroesofágica ou "artéria lusória". A artéria subclávia direita retroesofágica é comumente descrita como assintomática, sendo os achados, na maioria das vezes, acidentais. Entretanto, essa artéria pode ser um sítio de formação de placas ateromatosas, lesões inflamatórias ou até aneurismas. RELATO DE CASO: O presente estudo descreve um caso de artéria subclávia direita retroesofágica e discute os achados de acordo com sua importância clínica e implicações cirúrgicas. CONCLUSÃO: Variações anatômicas do arco aórtico e seus ramos são significantes para diagnósticos e procedimentos cirúrgicos do pescoço e do tórax. Caso uma artéria subclávia direita retroesofágica seja diagnosticada durante uma cirurgia do arco aórtico, um procedimento corretivo deve ser considerado. Pacientes em terapia intensiva devem ser investigados para a presença dessa variação anatômica antes de uma sondagem nasogástica de longa duração para se evitar complicações como fístulas e hemorragia.