Case series and a systematic review concerning the level of the aortic bifurcation.

BACKGROUND: The aim of this study is to present the level of aortic bifurcation in a sample of Greek origin (case series) and to perform an up-to-date systematic review in the existing literature. MATERIALS AND METHODS: Seventy-six formalin-fixed adult cadavers were dissected and studied in order to research the level of aortic bifurcation. Additionally, PubMed and Google Scholar databases were searched for eligible articles concerning the level of aortic bifurcation for the period up to February 2020. RESULTS: The mean level of aortic bifurcation according to our case series was the lower third of the L4 vertebral body (21/76, 27.6%). The level of aortic bifurcation ranged between the lower third of the L3 vertebral body and the lower third of the L5 body. No statistically significant correlation was found between the two sexes. The systematic review of the literature revealed 31 articles which were considered eligible and a total number of 3537 specimens were retracted. According to the recorded findings the most common mean level of aortic bifurcation was the body of L4 vertebra (1495/3537 cases, 42.2%), while the range of aortic bifurcation was described to occur from upper third of L3 vertebrae to the upper third of the S1 vertebrae in the 52.8% of the cases (1866/3537). CONCLUSIONS: The mean level of AA corresponds to the body of L4 and presents a great range (form L3U to S1U). Knowledge of the mean level of aortic bifurcation and its probable ranges is of great significance for interventional radiologists and especially vascular surgeons that deal with aneurism proximal to the aortic bifurcation.

Vertebral artery variations revised: origin, course, branches and embryonic development.

BACKGROUND: The vertebral artery originates from the subclavian artery and is divided into four segments. The aim of this study is to investigate the anatomical variations in the course and branches of the vertebral artery. MATERIALS AND METHODS: A research was performed via PubMed database, using the terms: "variations of vertebral artery AND cadaveric study", "variations of vertebral artery AND cadavers" and "anomalies of vertebral artery AND cadavers". RESULTS: A total of 24 articles met the inclusion criteria, 13 of them referring to variations of the origin of the vertebral artery, 9 to variations of the course and 3 to variations of its branches. On a total sample of 1192 cadavers of different populations, origin of the left vertebral artery directly from the aortic arch was observed at 6.7%. In addition, among 311 cadavers, 17.4% were found with partially or fully ossified foramen of the atlas for the passage of the vertebral artery, while the bibliographic review also showed variants at the exit site of the artery from the transverse foramen of the axis. CONCLUSIONS: Despite the fact that variations of both the course and the branches of vertebral artery are in most cases asymptomatic, good knowledge of anatomy and its variants is of particular importance for the prevention of vascular complications during surgical and radiological procedures in the cervix area.

Anatomical study of the common iliac arteries.

BACKGROUND: The common iliac arteries (CIA) are the two terminal branches of the abdominal aorta which supply the pelvis and the lower extremities. The present study aims to examine the morphometric features of the CIA in a cadaveric sample and possible correlations between lengths. MATERIALS AND METHODS: Seventy-six formalin fixed cadavers of Greek origin were dissected in the Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens. In each cadaver dissected, the abdominal aorta and the CIA were identified and their lengths were measured. Also the torso length was measured and the height of each cadaver. All the statistical analysis was done by SPSS 15.0. RESULTS: The mean length of the left CIA was 6.12 cm (SD: ± 1.791, SE: 0.205) and that of the right one was 6.03 cm (SD: ± 1.607, SE: 0.184). The lengths of the CIA differed between the sexes, but no statistically significant difference was observed. Statistically significant differences regarding the torso lengths and body heights were found between the sexes, as well as a statistically strong correlation between the lengths of the left and right CIA in the cadavers dissected. CONCLUSIONS: The knowledge of the anatomy and morphology of the CIA is ofgreat clinical significance, given that abnormal course, length or branching pattern of these vessels are not uncommon and their clinical impact may be great. Mostly interventional radiologists and vascular surgeons should be aware of this knowledge.

An aperture in the sagittal plane of the dorsal wall of the sacrum.

The dorsal wall of the sacrum presents various anatomical variations, while the dorsal bony wall of the sacral canal suffers more. We report a case of a sacrum with a series of variants in the midline due to abnormal ossification and a bizarre aperture on the sagittal plane between the 1st and the 2nd sacral spinous processes. A failure of the ossification patter during embryological life, or an ossification of the supraspinous ligament may result in such an aperture. Sacrum variety is of great importance for the daily proper medical practice.

An unusual case of asymmetrical combined variations of the subclavian and axillary artery with clinical significance.

In a Greek Caucasian male cadaver, a combination of the following arterial variations were observed: an aberrant right subclavian artery originating as a last branch of the aortic arch and coursed posterior to the oesophagus, a right non-recurrent laryngeal nerve, an atypical origin of the left suprascapular artery from the axillary artery, an unusual emersion of the lateral thoracic artery from the subscapular artery and a separate origin of the left thoracodorsal artery from the axillary artery. According to the available literature the corresponding incidences of the referred variants are: 0.7% for the aberrant right subclavian artery, 1.6-3.8% for the origin of the suprascapular artery from the axillary artery, 3% for the origin of the left thoracodorsal artery from the axillary artery and 30% for the origin of the lateral thoracic artery from the subscapular artery. Such unusual coexistence of arterial variations may developmentally be explained and has important clinical significance.

A lower polar additional renal artery in an ectopic intraperitoneal kidney.

BACKGROUND: The kidneys are positioned retroperitoneally and they are normally supplied by the paired renal arteries. We describe a long left additional renal artery which supplies the lower pole of an intraperitoneal, labile, and smaller than usual left kidney, a variation that might complicate uroradiological procedures or surgery and cause failure of lithotripsy. MATERIAL AND METHODS: The reported anatomical variations were discovered during routine educational dissection in a female cadaver. RESULTS: The left kidney was found inside the parietal peritoneum (intraperitoneal), and it was lying free among the small bowel loops, without any underlying supportive tissues. Moreover, it was smaller than it should have been (length: 9.3 cm, diameter 3.1 cm) and possessed a lower polar additional left renal artery rising from the lateral side of the abdominal aorta, passing posterior to the ureter, and which was rather long (length: 8.8 cm). At the right side we did not find any variations of the renal region. CONCLUSIONS: Such a variation should be taken into consideration as it may lead to complications or explain some of them, if they occur.