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Table of Contents    
LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 6  |  Page : 1844-1845

Anomalous Origin of Bilateral Vertebral Arteries with Retroesophageal Right Subclavian Artery: A Rare Anomaly with Associated Fetal Origin of Bilateral Posterior Cerebral Arteries


Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Date of Submission04-Feb-2018
Date of Decision14-Mar-2018
Date of Acceptance06-Dec-2019
Date of Web Publication23-Dec-2021

Correspondence Address:
Dr. Chirag K Ahuja
Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.333530

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How to cite this article:
Ahuja CK, Moudgil S, Khandelwal N. Anomalous Origin of Bilateral Vertebral Arteries with Retroesophageal Right Subclavian Artery: A Rare Anomaly with Associated Fetal Origin of Bilateral Posterior Cerebral Arteries. Neurol India 2021;69:1844-5

How to cite this URL:
Ahuja CK, Moudgil S, Khandelwal N. Anomalous Origin of Bilateral Vertebral Arteries with Retroesophageal Right Subclavian Artery: A Rare Anomaly with Associated Fetal Origin of Bilateral Posterior Cerebral Arteries. Neurol India [serial online] 2021 [cited 2022 Jan 20];69:1844-5. Available from: https://www.neurologyindia.com/text.asp?2021/69/6/1844/333530




Dear Sir,

There have been wide variations described in medical literature regarding the origin of major vessels from the arch of aorta. With the recent rise in the frequency of endovascular procedures, prior knowledge of neurovascular anatomy including such variations is of paramount importance for successful patient outcomes. We report an unusual case of multiple arterial anomalies in a 57-year-old-male patient, who underwent cervicocranial computed tomography (CT) angiography as a part of evaluation for chronic recurrent headaches. There was aberrant origin of right vertebral artery (R-VA) from lateral wall of right common carotid artery (R-CCA) [Figure 1]a, which was coursing posteriorly to reach its medial aspect, continuing superiorly on the medial aspect of R-CCA, and entering the transverse foramen of right C4 vertebra [Figure 1]b. The left vertebral artery took direct origin from the aortic arch, between the origins of left common carotid and left subclavian artery [Figure 1]b. The right subclavian artery also had an anomalous origin from the left side of aortic arch with a retroesophageal course [Figure 2]a. Notably, bilateral posterior cerebral arteries were fetal in origin [Figure 2]b.
Figure 1: CT angiography maximum intensity projection oblique image (a) showing right vertebral artery originating from right common carotid artery (arrow). Volume rendered image anteroposterior view (b) demonstrating the origin of R-VA from lateral aspect of R-CCA (arrow), crossing posteriorly to reach medial aspect and coursing superiorly and finally entering the C4 transverse foramen (arrowhead). L-VA is directly originating from aortic arch (star)

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Figure 2: Right subclavian artery shows anomalous origin from aortic arch (arrow) on the left side with a retroesophageal course (a). Note is made of fetal origin of bilateral posterior cerebral arteries (b)

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Wide variations in the origin of major cervicocranial arteries from the arch of aorta, in different combinations, are reported in the medical literature.[1] R-VA origin anomalies are rare. It may arise from arch of aorta, right carotid artery, brachiocephalic trunk, or a duplicated origin. R-VA originating from R-CCA, that too, with retro-esophageal right subclavian artery (RERSA) is rarer still. Tsai et al. reported right VA originating from the right CCA in 13.7% of 102 RERSA cases, and left VA originating as the direct branch from the aortic arch, between left CCA and left subclavian artery origins, in 28.6% in same study.[2] Therefore the incidence of anomalous origin of bilateral VAs along with RERSA, as in the present case and in addition, bilateral fetal PCA is an extremely rare occurrence.

This anomalous aortic branching may alter the vascular hemodynamics distally with increased risk of aneurysm formation, vascular thrombosis and subsequent occlusion, arterial dissection, and atherosclerosis.[3],[4] In the present times, where endovascular procedures and head neck surgeries are a common practice, prior knowledge of such anomalies may avert inadvertent cerebrovascular event during endovascular or surgical procedures. It may also reduce fluoroscopy times, shorten the procedure with lesser radiation and contrast requirements especially in cases where time is crucial like in stroke patients. The chances of intraprocedural traumatic injury would also be reduced while searching for “vessels not found at expected anatomical sites.” Such information would also help the surgeons operating upon the aortic arch or head and neck region.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fazan VP, Ribeiro RA, Ribeiro JA, Filho OA. Right retroesophageal subclavianartery. Acta Cir Bras 2003;18(Suppl 5):54-56.  Back to cited text no. 1
    
2.
Tsai IC, Tzeng WS, Lee T, Jan SL, Fu YC, Chen MC, et al. Vertebral and carotid artery anomalies in patients with aberrant right subclavian arteries. Pediatr Radiol 2007;37:1007-12.  Back to cited text no. 2
    
3.
Wasserman BA, Mikulis DJ, Manzione JV. Origin of the right vertebral artery from the left side of the aortic arch proximal to the origin of the left subclavian artery. Am J Neuroradiol 1992;13:355-8.  Back to cited text no. 3
    
4.
Lemke AJ, Benndorf G, Liebig T, Felix R. Anomalous origin of the right vertebral artery: Review of the literature and case report of right vertebral artery origin distal to the left subclavian artery. Am J Neuroradiol 1999;20:1318-21.  Back to cited text no. 4
    


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