Case Report
Five Cases of an Accessory Left Vertebral Artery on the Aortic Arch
Guinevere Granite*
Corresponding Author: Dr. Guinevere Granite, Ph.D., Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
Received: December 17, 2018; Accepted: December 28, 2018; Published: January 14, 2019;
Citation: Granite G. (2019) Five Cases of an Accessory Left Vertebral Artery on the Aortic Arch. Int J Clin Case Stud Rep, 1(1): 10-12.
Copyrights: ©2019 Granite G. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 

This is a review of an article presented in the Journal of Case Reports and Studies entitled “Five Cases of an Accessory Left Vertebral Artery on the Aortic Arch”. Each case presents unique aspects illustrating developmental variations that can occur in the individuals who choose to donate their bodies to science. The five cases presented with an accessory left vertebral artery originating from the aortic arch, between the left common carotid artery and the left subclavian artery.

 

Keywords: Accessory left vertebral artery, Duplicate origin of the left vertebral artery, Vertebral artery variation, Head and neck vascular variations

This article presents five cases of both male and female cadavers who exhibited an accessory left vertebral artery (ALVA) originating directly from the arch of the aorta, between the left common carotid artery (LCCA) and the left subclavian artery (LSA), in addition to a left vertebral artery (LVA) branching off the LSA. These five instances of an ALVA detected during a cadaveric review of 64 specimens, demonstrated a prevalence of 7.81%. Among the five specimens, there were further unique deviations from the norm.

This article describes five case studies involving the rare vascular variant known as unilateral duplicate origin of the vertebral artery or accessory vertebral artery. Accessory vertebral artery (AVA) is considered a developmental anatomical variation that involves dual origin of the vertebral artery with a variable level of fusion in the neck [1-6]. It is usually clinically asymptomatic but may alter cerebral hemodynamics. This may cause cerebral dysfunction and predispose individuals to cerebrovascular pathologies, such as aneurysm and/or a dissection [1,5,7-23].

Although the reported incidence of AVA is between 0.295 and 0.72% [1,2,7,8,24-26], this article presents a cadaveric population of 64 randomly selected specimens with a prevalence of 7.81%. The prevalence of this anatomical variant illustrates the potential frequency and thus, the clinical importance of extensive anatomical understanding of head and neck vascular variations.

The case studies presented in this article include: a white 65 year old male (Case 1), a white 89 year old female (Case 2), a white 80 year old female (Case 3), a White 96 year old female (Case 4) and a white 95 year old female (Case 5). Each specimen presented with an accessory left vertebral artery (ALVA) originating from the aortic arch, between the left common carotid artery and the left subclavian artery. All five case studies also presented with a left vertebral artery (LVA) branching from the left subclavian artery. To assess the ALVA and LVA accurately, while also examining the right vertebral artery (RVA) for any variations, the entire cervical vertebral column and cranium was extensively dissected for each specimen. Several additional vascular variants were discovered during these dissections. These involved the vertebral arteries, circle of Willis and cerebellum. These variants included stenosis of the LVA and RVA; unilateral absence of the Posterior Inferior Cerebellar Arteries (PICAs); hypoplasia of the Anterior Inferior Cerebellar Arteries, Posterior Communicating Arteries (PCAs) and Posterior Cerebral Arteries; and dilation of the PICAs and PCAs.

In the medical academic context, it is essential to teach students to dissect the head and neck region with care. Meticulous dissection permitted detection of the ALVAs in these case studies. In the clinical setting, vascular variations of the head and neck are common. However, they often go undetected due to their general lack of clear clinical symptoms. Knowledge of the presence and location of such variations is critical since surgical errors in this region may result in iatrogenic complications or even fatalities. Given the potential clinical significance of ALVAs, physicians and surgeons should be aware of such variations.

1.       Kim MS (2018) Duplicated vertebral artery: Literature review and clinical significance. J Korean Neurosurg Soc 61: 28-34.

2.       Baik J, Baek HJ, Shin HS, Choi KH (2016) Duplication of the right vertebral artery: MRA findings and review of the literature. Springer Plus 5: 1123.

3.       Ionete C, Omojola MF (2006) MR angiographic demonstration of bilateral duplication of the extracranial vertebral artery: Unusual course and review of the literature. AJNR Am J Neuroradiol 27: 1304-1306.

4.       Goddard AJ, Annesley-Williams D, Guthrie JA, Weston M (2001) Duplication of the vertebral artery: Report of two cases and review of the literature. Neuroradiol J 43: 477-480.

5.       Melki E, Nasser G, Vandendries C, Adams D, Ducreux D, et al. (2012) Congenital vertebral duplication: A predisposing risk factor for dissection. J Neurol Sci 314: 161-162.

6.       Ozpinar A, Magill ST, Davies JM, McDermott MW (2015) Vertebral artery fenestration. Cureus 7: e245.

7.       Gupta OMP, Gupta KK, Qasim M, Rameshbabu CS (2014) Bilateral asymmetrical duplicated origin of vertebral arteries: Multidetector row CT angiographic study. Indian J Radiol Imaging 24: 61-65.

8.       Yuan SM (2016) Aberrant origin of vertebral artery and its clinical implications. Braz J Cardiovasc Surg 31: 52-59.

9.       Jung S, Jung C, Jung Bae Y, Se Choi B, Hyoung Kim J (2016) Duplicated origin of the left vertebral artery: A case report and embryological review. Neurointervention 11: 50-54.

10.    Lemke AJ, Benndorf G, Liebig T, Felix R (1999) 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. AJNR Am J Neuroradiol 20: 1318-1321.

11.    Thomas AJ, Germanwala AV, Vora N, Prevedello DM, Jovin T, et al. (2008) Dual origin extracranial vertebral artery: Case report and embryology. J Neuroimaging 18: 173-176.

12.    Rameshbabu CS, Gupta OMP, Gupta KK, Qasim M (2014) Bilateral asymmetrical duplicated origin of vertebral arteries: Multidetector row CT angiographic study. Neuroradiol J 24: 61-65.

13.    Rieger P, Huber G (1983) Fenestration and duplicate origin of the left vertebral artery in angiography. Report of three cases. Neuroradiol J 25: 45.

14.    Takasato Y, Hayashi H, Kobayashi T, Hashimoto Y (1992) Duplicated origin of right vertebral artery with rudimentary and accessory left vertebral arteries. Neuroradiol J 34: 287-289.

15.    Alsaif HA, Ramadan WS (2010) An anatomical study of the aortic arch variations. JKAU Med Sci 17: 37-54.

16.    Satheesha BN, Sirasanagandla SR, Surekha DS, Deepthinath R, Sudarshan S, et al. (2014) Variant origin of the left vertebral artery from a vertebro-subclavian trunk associated with an unusual branch arising from the brachiocephalic trunk. J Surg Academia 4: 73-75.

17.    Shi SK (2017) Arterial vascular variation of the head and neck and its clinical significance. J Neurol Neurophysiol 8: 442-443.

18.    Bernardi L, Dettori P (1975) Angiographic study of a rare anomalous origin of the vertebral artery. Neuroradiol J 9: 43-47.

19.    Dare AO, Chaloupka JC, Putman CM, Meyer PL, Schneck MJ, et al. (1997) Vertebrobasilar dissection in a duplicated cervical vertebral artery: A possible pathoetiologic association? A case report. Vasc Endovascular Surg 31: 103-109.

20.    Satti SR, Cerniglia CA, Koenigsberg RA (2007) Cervical vertebral artery variations: An anatomic study. AJNR Am J Neuroradiol 28: 976-980.

21.    Kendi AT, Brace JR (2009) Vertebral artery duplication and aneurysms: 64 slice multidetector CT findings. Br J Radiol 82: e216-218.

22.    Komiyama M, Morikawa T, Nakajiman H, Nishikawa M, Yasui T (2001) High incidence of arterial dissection associated with left vertebral artery of aortic origin. Neurol Med Chir (Tokyo) 41: 8-11.

23.    Kim DW (2009) Concomitant dual origin and fenestration of the left vertebral artery resembling dissection. J Korean Neurosurg Soc 46: 498-500.

24.    Bergman RA, Thompson SA, Afifi AK, Saadeh FA (1988) Compendium of human anatomic variation: Text, atlas and world literature. Baltimore: Urban and Schwarzenberg 71-72: 358-359.

25.    Mahmutyazicioğlu K, Saraç K, Bölük A, Kutlu R (1998) Duplicate origin of left vertebral artery with thrombosis at the origin: Color doppler sonography and CT angiography findings. J Clin Ultrasound 26: 323-325.

26.    Polguj M, Jęrdzejewski K, Topol M, Wierczorek-Pastusiak J, Majos A (2013a) Duplication of the left vertebral artery in a patient with dissection of the right internal carotid artery and Ehlers-Danlos syndrome: Case report and review of the literature. Anat Sci Int 88: 109-114.