Case report: Right vertebral and carotid artery anomalies with an aberrant right subclavian artery in two patients.

Abnormal origins of the vertebral artery with supra-aortic vessel variants are exceedingly uncommon. Herein, we present two cases of the vertebral artery originating from the right common carotid artery associated with the right subclavian artery arising separately as the initial branch of the aortic arch, followed by the right common carotid artery. We reviewed the embryology of the anomalous origins of the vertebral and subclavian arteries. These variants can significantly affect surgical planning and cause severe clinical symptoms.

A rare adult case of asymptomatic double aortic arch accompanied by the right vertebral artery directly originating from the aortic arch.

INTRODUCTION: A double aortic arch (DAA) is a rare congenital vascular anomaly. No case of DAA with a direct aortic origin of the right vertebral artery (VA) has been reported in adults. Here, we report a rare case of an asymptomatic DAA accompanied by the right VA directly originating from the right aortic arch in an adult. CASE PRESENTATION: A DAA and right VA directly originating from the right aortic arch were identified in a 63-year-old man using digital subtraction angiography and computed tomography angiography. The patient underwent digital subtraction angiography for evaluation of an unruptured cerebral aneurysm. Intraprocedural selection of vessels branching from the aorta with the catheter was difficult. To confirm the bifurcation of the aorta, aortography was performed, which revealed a DAA. Following digital subtraction angiography, computed tomography angiography was performed, which showed that the right VA originated directly from the right aortic arch. The trachea and esophagus were located in the vascular ring of the DAA; however, they were not compressed by the aorta. This was consistent with the lack of symptoms related to the DAA. CONCLUSIONS: This is the first adult case of an asymptomatic DAA with an unusual origin of the VA. A rare asymptomatic vascular anomaly, such as a DAA, can be incidentally identified using angiography.

Degenerative cervical myelopathy caused by posttraumatic severe atlantoaxial dislocation over 10 years in patients with right vertebral artery hypoplasia: A case report of successful management.

INTRODUCTION: Degenerative cervical myelopathy caused by long-standing neglected AAD is rare, especially in severe cases. Combined with the exceptional right vertebral artery hypoplasia condition, treatment must be integrated into multitherapy to avoid fatal complications. CASE: A 55-year-old man presented with degenerative cervical myelopathy caused by posttraumatic severe atlantoaxial dislocation for more than 10 years in patients with right vertebral artery hypoplasia. After treatment with halo traction and C1 lateral mass, as well as C2 pedicle screw fixation combined with bone autoplasty, the condition was resolved. CONCLUSION: This is an extremely rare and severe condition (anatomical damage, long-term sequelae, degree of paralysis on admission, and complete hypoplasia of the right vertebral artery). The treatment strategy is consistent with early favorable outcomes.

Right Vertebral Artery Arising From Ipsilateral Common Carotid Artery With Severe Stenosis of Ostio-proximal Segment of Aberrant Right Subclavian Artery: A Rare Life-Saving Variant.

Anomalous origins of vertebral arteries are rare vascular anomalies that are incidentally identified during computed tomography, magnetic resonance imaging, or digital subtraction angiograms. We present the case of a 45-year-old male who had gangrene of the right ring finger associated with absent radial, ulnar, and brachial artery pulses. A computed tomography angiogram of the upper limb including the arch of aorta showed an aberrant right subclavian artery having near-total stenosis at the origin. An anomalous origin of the right vertebral artery from the right common carotid artery was also noted. This incidental variant anomaly of the vertebral artery was vital in this case as it spared the posterior cerebral circulation from vascular insufficiency complications. It is also important for future head and neck endovascular interventions to avoid inadvertent arterial injury.

Hybrid repair for Kommerell's diverticulum and right aortic arch with aberrant right vertebral artery.

Kommerell's diverticulum (KD) is a rare aneurysm of the origin of an aberrant subclavian artery. Hybrid aortic arch repair for KD is being performed more often. We report hybrid arch repair for KD in a 63-year-old man with a right aortic arch and aberrant right vertebral artery, an extremely rare variant. We performed total arch replacement to completely reconstruct the five cervical arteries with elephant trunk to create an adequate landing zone, followed by second-stage endovascular stent-grafting from the ascending aorta to the proximal descending aorta.

Right vertebral artery arising from the right common carotid artery without association with an aberrant right subclavian artery and entering the C3 transverse foramen.

The right vertebral artery (VA) rarely arises from the right common carotid artery (CCA); however, the majority of anomalous right VAs are seen in combination with an aberrant right subclavian artery (SA). Independent (or isolated) right VA of the right CCA origin is extremely rare, with only a few cases reported previously. We herein report an additional case diagnosed incidentally using computed tomography angiography. This patient had a left VA arising from the aortic arch between the origins of the left CCA and left SA. The bilateral VAs took an anterior course and entered the C3 transverse foramina, at an extremely high level.

Aberrant origin of right vertebral artery from the arch of aorta.

We present a rare case of an aberrant right vertebral artery originating from the arch of aorta distal to the origin of the left subclavian artery. The incidence of this particular variant of aberrant origin of the right vertebral artery is extremely uncommon with only seventeen cases reported in literature to date. This case was incidentally detected on a staging positron emission tomography-computerized tomography (PET-CT) scan for lung cancer. We review the incidence, embryological mechanism, and clinical importance of this aberrant course of the right vertebral artery.

Anomalous origin of right vertebral artery from right common carotid artery.

Anomalous origin of vertebral arteries is a rare vascular anomaly and mostly discovered as incidental findings during computed tomography angiogram , magnetic resonance angiography or digital subtracted angiogram of the aortic arch and cerebral vessels. Herein, we present an extremely rare case of a 31-year-old female who presented with headache after emotional trauma. A conventional cerebral angiogram showed anomalous origin of the right vertebral artery. This finding was incidentally discovered, and it is of utmost importance for future head and neck endovascular interventions to avoid inadvertent arterial injury.

The right vertebral artery arising from the right common carotid artery: report of a rare case.

Anomalous origins of the vertebral arteries are uncommon and generally associated with other abnormalities of the supra-aortic vessels. We present an extremely rare case where the right vertebral artery is arising from the right common carotid artery, with an absent brachiocephalic trunk, and the right common carotid artery as the first branch of the aortic arch followed by right subclavian artery, without any other abnormalities of the supra-aortic vessels. This vessel variation can affect endovascular procedures, surgical interventions and cause some unexpected clinical symptoms.

Anomalous triple origin and neck mergers of a vertebral artery.

Accurate knowledge of the variant origin of the vertebral arteries (VAs) is important in vascular surgery and angiographic procedures in the neck. A triple origin of the VA is extremely rare. We report the first adult case of triple origin of the right VA from the right subclavian artery (SA). This report demonstrates magnetic resonance (MR) angiography findings of this unusual anatomic variation .

Aberrant Right Vertebral Artery with a Diverticulum of Kommerell: Review of a Rare Aortic Arch Anomaly.

The normal aortic arch branching pattern is of a three-vessel arch with the vertebral arteries arising from the subclavian arteries. There are a variety of well-known symptomatic and asymptomatic aortic branching patterns widely reported in the literature. An anomalous right vertebral artery with a diverticulum of Kommerell is an extremely rare variant, with few other cases reported in the literature. Herein, we review the embryology of the aortic arch and vertebral artery, the various types of Kommerell's diverticula and the clinical significance of this anomaly.

Anomalous Origin of the Right Vertebral Artery from the Right Common Carotid Artery.

The anomalous origin of the right vertebral artery (VA) from the right common carotid artery (CCA) is a rare vascular anomaly, which is usually clinically asymptomatic and found incidentally during angiographic examinations. This anomaly is invariably associated with an aberrant right subclavian artery (RSCA). Approximately 31 cases have been reported in the literature. We present a case of a right VA originating from the right CCA in a patient with Down syndrome and discuss the imaging findings, embryological etiology of the anomaly, as well as its implications for endovascular/surgical treatment.

The right vertebral artery originating from the right occipital artery and the absence of the transverse foramen: a rare anatomical variation.

Variations in the origin of the vertebral artery (VA) is a congenital anomaly that occurs during embryological development. Multiple variations related to VA origin have been reported in the literature. Abnormal VA origin is usually determined as incidental findings during angiographic or postmortem anatomical studies. Although most of the cases are asymptomatic, in patients with VA anomaly symptoms such as dizziness have been described. The anomalous variation in the origin of the right VA is rare and separated into three categories: (1) originating from the aorta, (2) originating from the carotid arteries, (3) duplicated origin. In this case, we aimed to present the right VA originating from the right occipital artery and concomitant anomalies of the transverse foramen that have not been reported previously according to our knowledge in literature. In a 32-year-old female patient referred to our hospital because of dizziness, the right VA was not observed on magnetic resonance imaging and computed tomography angiography (CTA) examination was performed. CTA showed hypoplasia of the right transverse foramen at the levels of the C1, C5 and C6 vertebrae and aplasia of the right transverse foramen at the levels of the C2, C3 and C4 vertebrae. The right VA originating from the right occipital artery continues to its normal course by entering the cranium through the foramen magnum at the level of the atlantooccipital junction.

Anomalous right vertebral artery arising from the arch of aorta: report of three cases.

The right vertebral artery most commonly originates as the first branch of the right subclavian artery. Although anatomical variants of the aortic arch are commonly encountered on cross-sectional imaging, certain variants of the right vertebral artery are exceedingly rare. In this report, we present 3 cases of aberrant right vertebral artery arising as the last branch of the aortic arch, a very rare variant.

Duplicate origin of the right vertebral artery in which both channels arose from the extreme proximal right subclavian artery: a case report.

Rarely, two channels of the right vertebral artery (VA) arise from the right subclavian artery (SA) and fuse at the level of the C5 or C4 transverse foramen, a variation of the artery termed duplicate origin. Usually, one channel arises from the normal position, and the second arises from the extreme proximal segment of the SA. We report a case of duplicate origin of the right VA in which both channels arose from the extreme proximal segment of the SA, which we diagnosed by computed tomography (CT) angiography. The smaller channel entered the C5 transverse foramen and the larger channel, the C4 transverse foramen, and they fused at the level of the C4. Careful scrutiny of CT angiographic source images is important to detect rare arterial variations, especially to identify the level at which the VA enters the transverse foramen.

Anomalous Origin of the Right Vertebral Artery: Incidence and Significance.

OBJECTIVE: Detailed knowledge about anatomic variations of the aortic arch and its multiple branches is extremely important to endovascular and diagnostic radiologists. It is often hypothesized that anomalous origin and distribution of large aortic vessels may alter the cerebral hemodynamics and potentially lead to a vascular pathology. METHODS: In this article, we describe a case of anomalous origin of the right vertebral artery, which was detected during an intervention. We further reviewed the available literature of anomalous origin of the right vertebral artery. The probable embryologic development and clinical significance are discussed. RESULTS: The incidence of anomalous origin of a vertebral artery seems to be underestimated in recent literature. A careful review of the literature shows more than 100 such cases. The right vertebral artery can arise from the aortic arch or one of its branches. Dual origin of the vertebral artery is not uncommon. The embryologic developmental hypotheses are contradictory and complex. CONCLUSIONS: Anomalous origin of the right vertebral artery may not be the sole reason behind a disease process. However, it can certainly lead to a misdiagnosis during diagnostic vascular studies. Detailed information is essential for any surgery or endovascular intervention in this location.