[A case of the right subclavian artery as the last branch of the aortic arch in the human fetus and a new classification on these variations].

ABSTRACT

An anomalous case of the right subclavian artery arising from the aortic arch as the last branch, in which the first branch was the right common carotid, the second the left common carotid and the third the left subclavian artery, was found in a 10 months human fetus among 173 fetuses. The right subclavian artery arose from the posterior wall of the aortic arch at the level of the Th4 and passed obliquely between the esophagus and the thoracic vertebrae. The right and the left vertebral arteries arising from the subclavian arteries on the same side entered the transverse foramen of the C6 of each side. This case belonged to type G of Adachi's classification and as well type 5 of Holzapfel's. The present authors wish to offer a new trial classification on these variations, including the origins and numbers of the vertebral arteries, by investigating many original reports in Japanese, as follows 1) A new classification is fixed on the basis of the type G and H of Adachi-Williams et al.-Nakagawa in the classification of the branching types of the aortic arch. The type G represents that the right common carotid, the left common carotid, the left subclavian and the right subclavian arteries arise from the aortic arch in this order. The type H represents that the bicarotid trunk, the left subclavian and the right subclavian arteries arise from the aortic arch. 2) When the left vertebral artery arising from the aortic arch is found in the type G and H, "C" is prefixed G or H, as type CG, type CH. 3) When the right vertebral artery arising from the right common carotid artery is found, a prime mark, ""', is put on G or H, as type G', type H'. 4) In order to represent a compound type of the above 2) and 3), both "C" and ""' are put, as type CG', type CH'. 5) When the bilateral vertebral arteries arising from the respective subclavian artery are found in the above 2), 3) and 4) "2" postfixed "C" and the prime mark ""', as type G'2, type C2G, type CG'2, type C2G', type C2G'2, type H'2, type C2H, type CH'2, type C2H', type C2H'2. According to the above new classification, Adachi's type G can be arranged into 18 branching types. This classification may be helpful and sufficient to provide more than 100 cases of the type G and H reported on Japanese.(ABSTRACT TRUNCATED AT 250 WORDS)