RESUMO
The common carotid artery (CCA) typically bifurcates into the external and internal carotid arteries (ECA and ICA). In the head and neck area, the ECA gives off a few anterior branches from proximal to distal: the superior thyroid artery (STA), the lingual artery (LA), and the facial artery (FA). Occasionally, these branches can fuse into trunks, with the linguofacial trunk being the most common. During a computed tomography angiography (CTA) of a 67-year-old patient, a common arterial trunk, 11.3 mm proximal (prior) to the CCA bifurcation was recorded. The trunk was formed by the STA and the LA fusion and was characterized as a thyrolingual trunk (TLT). These trunks have been reported with a prevalence ranging between 0.3 and 1% and correspond to one of the rarest variants of the ECA anterior branches. Knowledge of the typical and variant anatomy of the carotid arteries and their branches is of paramount importance to surgeons and interventional radiologists.
Assuntos
Variação Anatômica , Artéria Carótida Primitiva , Angiografia por Tomografia Computadorizada , Humanos , Idoso , Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/anormalidades , Glândula Tireoide/diagnóstico por imagem , Masculino , FemininoRESUMO
PURPOSE: To report an unusual absent right common carotid artery with embryological and clinical emphasis. METHODS: A 63-year-old female with a multilobulated anterior communicating artery saccular aneurysm was referred to our center for definite treatment. An analysis of her carotid system on CTA and DSA with 3D modeling was performed to assess the embryology of an absent right common carotid and its association with aneurysm development. RESULTS: Cerebral angiogram demonstrated an absent right common carotid artery and separate origin of the internal and external right carotid arteries arising from the brachiocephalic trunk. CONCLUSION: Absence of the common carotid artery is an uncommon anatomical variant, usually asymptomatic and commonly associated with other vascular abnormalities. It is important to be familiar with the association between this anatomical variant given its hemodynamic stress, high risk of stroke, and aneurysm formation.
Assuntos
Artéria Carótida Primitiva , Angiografia Cerebral , Imageamento Tridimensional , Aneurisma Intracraniano , Humanos , Feminino , Pessoa de Meia-Idade , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/anormalidades , Variação Anatômica , Angiografia por Tomografia Computadorizada , Angiografia DigitalAssuntos
Artéria Carótida Primitiva , Hemorragias Intracranianas , Humanos , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/anormalidades , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/anormalidades , Tomografia Computadorizada por Raios X , Pessoa de Meia-Idade , Resultado do Tratamento , Angiografia por Tomografia ComputadorizadaRESUMO
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.
Assuntos
Variação Anatômica , Artéria Carótida Primitiva , Angiografia por Tomografia Computadorizada , Humanos , Idoso , Feminino , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/anormalidades , Pescoço/irrigação sanguíneaRESUMO
The right and left vertebral arteries are the first branches of the ipsilateral subclavian arteries. However, in the presence of anatomical variation due to complex embryogenesis, the vertebral artery can arise directly from the aortic arch or any of its major branches. The atypical origin of the vertebral artery is commonly associated with the left vertebral artery. Anatomical variation in the origin of the right vertebral artery is rare. Most available reports are case reports from international studies. We report on a case of right vertebral artery arising from the ipsilateral common carotid artery with an absent brachiocephalic trunk in a South African patient examined by digital subtraction angiography. Reports on anatomical variations are of diagnostic importance prior to surgical interventions or endovascular treatment of cerebrovascular diseases such as cerebral aneurysms and arteriovenous malformations.
Assuntos
Tronco Braquiocefálico , Artéria Vertebral , Aorta Torácica/anormalidades , Tronco Braquiocefálico/anormalidades , Tronco Braquiocefálico/diagnóstico por imagem , Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Humanos , Artéria Subclávia/anormalidades , Artéria Vertebral/anormalidades , Artéria Vertebral/diagnóstico por imagemRESUMO
INTRODUCTION: Congenital aortic arch anomalies and variants have been extensively characterized in the medical literature. Proper identification of these anomalies is important when surgical or percutaneous interventions are indicated. CASE PRESENTATION: We present a case of a 48-year old male who presented to the emergency department with altered mental status. Magnetic resonance angiography (MRA) findings revealed an aberrant right subclavian artery (ARSA), early bifurcation of the right common carotid artery (CCA) with anomalous origin of the right vertebral artery (VA) from the right common carotid artery bifurcation, anomalous left vertebral artery originating from the aortic arch, and absent left common carotid artery with independent origins of the left external carotid artery (ECA) and internal carotid artery (ICA). No other abnormalities were identified, and the patient demonstrated no symptoms attributable to his vascular anomalies. CONCLUSION: To our knowledge, this unique combination of anomalies has never been reported in the literature. With an understanding of embryological pathways, even exceedingly rare anomalies like this one can be explained.
Assuntos
Anormalidades Cardiovasculares , Artéria Vertebral , Aorta Torácica , Artérias Carótidas/anormalidades , Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Artéria Vertebral/anormalidades , Artéria Vertebral/diagnóstico por imagemRESUMO
In the current study, we display a rare association of an aberrant innervation of the sternocleidomastoid muscle by the ansa cervicalis (AC) with a tortuous common carotid artery (TCCA). In specific, in a male cadaver we observed on the right side of the cervical region, a nerval branch of remarkable size originating from the most distal part of the AC's superior root and after piercing the superior belly of the omohyoid muscle innervated the distal portion of the sternocleidomastoid muscle. Furthermore, we noticed a tortuous course of the initial part of the right common carotid artery. We discuss the surgical significance of the awareness of AC's variations during neurotisation of the recurrent laryngeal nerve in cases of its damage, as well as the importance of aberrant innervation of the sternocleidomastoid muscle by AC for the preservation of muscle's functionality after accessory nerve's damage. Furthermore, we highlight the fact, that the knowledge of the relatively uncommon variant, such as TCCA is crucial for the physician in order to proceed more effectively in differential diagnosis of a palpable mass of the anterior cervical region or deal with symptoms such as dyspnea, dysphagia or symptoms of cerebrovascular insufficiency.
Assuntos
Artéria Carótida Primitiva/anormalidades , Plexo Cervical/anormalidades , Músculos do Pescoço/inervação , Cadáver , Humanos , MasculinoRESUMO
OBJECTIVE: To highlight the importance of imaging in reducing an accidental injury to the anomalous brachiocephalic trunk and its branches during tracheal surgery. CASE REPORT: This paper reports two cases of accidental injury to the great vessels in the neck during tracheal surgery. The first incident occurred during a repeat tracheostomy, when the right common carotid artery was injured. On reviewing the computed tomography images, the bifurcation of the brachiocephalic artery was seen to the left of the midline, and the right common carotid artery was adherent just below the tracheostomy site. The second incident happened during surgery for tracheal stenosis, when there was an inadvertent injury to the main brachiocephalic trunk, which was adherent to the trachea in the lower neck region. CONCLUSION: For airway surgeons, radiological assessment of vascular structures in relation to the trachea prior to surgery is as important as the endoluminal airway assessment for the best outcome.
Assuntos
Lesões Acidentais/prevenção & controle , Tronco Braquiocefálico/anormalidades , Pescoço/cirurgia , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Lesões Acidentais/epidemiologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/lesões , Tronco Braquiocefálico/cirurgia , Lesões das Artérias Carótidas/epidemiologia , Lesões das Artérias Carótidas/prevenção & controle , Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/irrigação sanguínea , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Estenose Traqueal/diagnóstico por imagem , Traqueostomia/efeitos adversos , Resultado do TratamentoRESUMO
We present a case of a 3-year-old boy with tetralogy of Fallot having the direct origin of the left external carotid artery from the aorta with a common trunk giving rise to the left internal carotid artery and left subclavian artery, in a right-sided aortic arch. We also highlight the potential implications in management.
Assuntos
Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Externa/anormalidades , Artéria Carótida Externa/diagnóstico por imagem , Artéria Carótida Interna/anormalidades , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/patologia , Artéria Carótida Primitiva/patologia , Artéria Carótida Externa/patologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Pré-Escolar , Angiografia por Tomografia Computadorizada , Ecocardiografia , Humanos , Masculino , Artéria Subclávia/patologiaRESUMO
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.
Assuntos
Variação Anatômica , Artéria Carótida Primitiva/anormalidades , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Artéria Vertebral/anormalidades , Angiografia Digital , Artéria Carótida Primitiva/diagnóstico por imagem , Procedimentos Endovasculares/instrumentação , Feminino , Cefaleia/etiologia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Oftalmoplegia/etiologia , Artéria Vertebral/diagnóstico por imagemAssuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Anormalidades Cardiovasculares/diagnóstico , Artéria Carótida Primitiva/anormalidades , Síndrome de DiGeorge/diagnóstico , Artéria Subclávia/anormalidades , Malformações Vasculares/diagnóstico , Aorta Torácica/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Humanos , Imageamento Tridimensional , Lactente , MasculinoRESUMO
PURPOSE: Persistent hypoglossal artery (PHA) is the second most common anastomosis between the carotid and vertebrobasilar systems and it demonstrates some variations. METHODS: Using magnetic resonance angiography, we diagnosed a case of low origin of the PHA associated with the high carotid bifurcation, and the resulting origin close to the carotid bifurcation. RESULTS: The PHA is typically clinically silent as in our case, but it could be a potential cause of glossopharyngeal neuralgia, hypoglossal palsy, and intracranial aneurysms or technical complications in interventional procedure such as carotid stenting. CONCLUSIONS: We have described a case of low origin of the PHA associated with high carotid bifurcation. To the best of our knowledge, no similar case has been reported in the English-language literature.
Assuntos
Artéria Basilar/anormalidades , Artéria Carótida Primitiva/anormalidades , Malformações Vasculares/diagnóstico , Idoso , Artéria Basilar/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Vértebras Cervicais , Humanos , Imageamento Tridimensional , Angiografia por Ressonância Magnética , Masculino , Pescoço , UltrassonografiaAssuntos
Anormalidades Múltiplas , Artéria Carótida Primitiva/anormalidades , Malformações Vasculares , Artéria Vertebral/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Criança , Dupla Via de Saída do Ventrículo Direito/complicações , Comunicação Interventricular/complicações , Humanos , Estenose da Valva Pulmonar/complicações , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagemRESUMO
Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.
Assuntos
Fístula Arteriovenosa/etiologia , Artéria Carótida Primitiva/anormalidades , Cateterismo Venoso Central/efeitos adversos , Veias Jugulares/anormalidades , Adulto , Humanos , MasculinoRESUMO
Blunt injuries of the great vessels arising from the aortic arch are usually fatal. The innominate artery lesions represent the most common site of injury after the aortic isthmus distal to the left subclavian artery. Injuries are usually located at the origin of the vessel from the aortic arch, especially in patients with bovine aortic arch. Open traditional repair is a successful but invasive treatment, with long hospital stay and different possible complications. Although a bovine aortic arch presents an increased technical challenge, it is possible to achieve a complete and safe repair of the innominate artery injuries through a total endovascular treatment, with important reduction of risks and complications related to operation, compared to traditional open repair. We report the case of a 62-year-old man in our hospital with a posttraumatic pseudoaneurysm of the innominate artery in the setting of a bovine aortic arch, associated with a transection of the descending thoracic aorta. In the urgent setting, the patient was submitted to a kissing stent of innominate artery-left common carotid artery and deployment of thoracic endoprosthesis to exclude the aortic transection, with good final result.
Assuntos
Falso Aneurisma/terapia , Aorta Torácica/lesões , Tronco Braquiocefálico/lesões , Artéria Carótida Primitiva/anormalidades , Procedimentos Endovasculares/instrumentação , Stents , Lesões do Sistema Vascular/terapia , Ferimentos não Penetrantes/terapia , Falso Aneurisma/diagnóstico por imagem , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Tronco Braquiocefálico/anormalidades , Tronco Braquiocefálico/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagemRESUMO
Common carotid artery usually bifurcates at the superior border of thyroid cartilage, corresponding to the C3-4 junction, however bifurcation level may vary. Common carotid bifurcation may have rare variations like separate origins of left internal and external carotid arteries from aortic arch, or bifurcation of common carotid artery within thoracic cavity. Intrathoracic carotid bifurcation is a rare variation with limited number of cases reported. The occurrence of a low carotid bifurcation seems to be embryologically related to the persistence of the ductus caroticus. Additionally, intrathoracic carotid bifurcation can be accompanied by findings of Klippel-Feil syndrome. Herein, we present imaging findings of an incidentally detected intrathoracic left common carotid artery bifurcation in a pediatric patient accompanied by fusion of the cervical vertebrae and ribs.
Assuntos
Artéria Carótida Primitiva/anormalidades , Vértebras Cervicais/anormalidades , Síndrome de Klippel-Feil/diagnóstico por imagem , Costelas/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Criança , Feminino , Humanos , Achados Incidentais , Radiografia Torácica , Costelas/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Artéria Carótida Primitiva , Artéria Carótida Externa , Artéria Carótida Interna , Aorta Torácica , Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Externa/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Humanos , Masculino , Adulto JovemAssuntos
Aorta Torácica/anormalidades , Anormalidades Cardiovasculares/complicações , Artéria Carótida Primitiva/anormalidades , Sons Respiratórios/etiologia , Artéria Subclávia/anormalidades , Malformações Vasculares/complicações , Artéria Vertebral/anormalidades , Aorta Torácica/diagnóstico por imagem , Anormalidades Cardiovasculares/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Humanos , Lactente , Masculino , Artéria Subclávia/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagemRESUMO
BACKGROUND: Kinking of the internal carotid artery is a cardiovascular (CV) risk factor. However, it remains unclear as to whether kinking of the common carotid artery (CCA) can also predict CV events. We conducted a long-term follow-up study to examine whether CCA kinking as assessed by carotid ultrasonography is a predictor of CV events in asymptomatic patients with CV risk factors. METHODS: We enrolled 598 patients (mean age, 66.8 ± 11.8 years) who were divided into two groups according to CCA kinking severity: kinking of 0-29° (Group I); and kinking at ≥30° (Group II). We assessed whether CCA kinking predicts CV events during follow-up. RESULTS: A total of 91 CV events were observed during the follow-up period (median, 124 months). Hypertension (P < .0001), prior CV events (P < .0001), CCA kinking (P < .0001), intima-media thickness (P < .0001), and max plaque score (P < .0001) were significantly higher in patients with CV events than those without. The age-adjusted hazard ratio of CCA kinking for CV events was 3.42 (95% CI: 2.2-5.3) in Group II compared to Group I. Cox proportional hazard regression analysis revealed that CCA kinking (HR: 3.02, 95% CI: 1.97-4.67), prior CV events (HR: 2.53 95% CI: 1.604.00), hypertension (HR: 2.19 95% CI: 1.17-4.57), and age (HR: 1.04, 95% CI: 1.02-1.07) were independent predictors of CV events. CONCLUSION: CCA kinking is a powerful independent predictor of CV events in asymptomatic patients with CV risk factors.