Classification and Frequency
E-Book, Englisch, 220 Seiten, ePub
ISBN: 978-3-13-258197-5
Verlag: Thieme
Format: EPUB
Kopierschutz: Wasserzeichen (»Systemvoraussetzungen)
Special Features:
Coverage of arterial variations in the head, neck, spine, thorax, abdomen and pelvis, and upper and lower extremities with separate chapters devoted to each major artery
Clearly drawn schematic outlines and their correlating high-quality radiological scans-more than 900 illustrations in total-highlight arterial variations
Images of the "normal" arterial anatomy as described in standard textbooks are provided for side-by-side comparison with the arterial variation
Percentages for the frequency of occurrence of arterial variations with references to the source of the data
Concise and lucid descriptions in each chapter facilitate complete comprehension of normal and abnormal vascular anatomy
With Arterial Variations in Humans: Key Reference for Radiologists and Surgeons, radiologists will gain a full understanding of the diversity of arterial anatomy-essential knowledge for the accurate interpretation of pathological changes in diagnostic imaging. Interventional radiologists and vascular and general surgeons will also find this book valuable for planning and performing procedures safely and effectively.
Zielgruppe
Ärzte
Autoren/Hrsg.
Fachgebiete
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Gefäßchirurgie
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Bildgebende Verfahren, Nuklearmedizin, Strahlentherapie Radiologie, Bildgebende Verfahren
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Herz- & Thoraxchirurgie
Weitere Infos & Material
1 Introduction
I Heart and Thorax
2 Aortic Arch
3 Coronary Arteries
4 Posterior Intercostal Arteries
5 Esophageal Arteries
6 Bronchial Arteries (Rami Bronchiales)
7 Pulmonary Arteries
II Pelvis and Abdomen
8 Development of the Abdominal Aorta
9 Inferior Phrenic Arteries
10 Suprarenal Arteries
11 Renal Artery
12 Testicular Artery
13 Celiac Trunk
14 Hepatic Arteries
15 Cystic Artery
16 Splenic Artery
17 Gastric Arteries
18 Pancreatic Arteries
19 Superior Mesenteric Artery and Celiac Trunk
20 Superior Mesenteric Artery and Colic Arteries
21 Appendicular Artery
22 Inferior Mesenteric Artery
23 Internal Iliac Artery
24 Arteries of the Female Genital Tract
25 Obturator Artery
III Lower Limbs
26 Development of the Arteries of the Lower Limb
27 The Profunda Femoris Artery
28 Popliteal Artery
29 Arteries of the Lower Leg
30 Dorsal Arteries of the Foot
31 Plantar Arch
IV Upper Limbs
32 Axillary Artery
33 Development of the Arteries of the Arm
34 Brachial Artery and Superficial Brachial Artery
35 Arteries of the Forearm
36 Superficial Palmar Arch
37 Deep Palmar Arch and Palmar Digital Arteries
38 Arteries on the Dorsal Side of the Hand
V Head and Spinal Cord
39 Subclavian Artery
40 Inferior Thyroid Artery
41 Vertebral Artery
42 External Carotid Artery
43 Maxillary Artery
44 Development of the Arteries of the Head
45 Ophthalmic Artery
46 Cerebral Arterial Circle (Circle of Willis)
47 Arteries of the Spinal Cord
2 Aortic Arch
D. Hortung, K. Hueper 2.1 Development of the Aortic Arch
During the early stages of embryonic development two pairs of aortas are present. The anterior aortas ascend from the heart, turn posteriorly within the first branchial arch, and descend as the posterior aortas. Already in embryos with 3-mm crown-heel length, the beginnings and ends of the paired aortas merge, remaining separate only in the area of the foregut. In each of the six branchial arches, connections develop between the anterior and posterior aortas, the branchial arteries. These arteries do not coexist, the first branchial arteries having already disappeared before the fifth and sixth develop. The fifth branchial artery seems to be present for a few hours only, although a few instances of its persisting have been reported.1–3 The carotid arteries develop from the cranial part of the anterior and posterior aortas. The posterior aortas give off segmental branches along their segmented body wall: 3 occipital, 7 cervical, and 12 thoracic, etc. All cervical arteries disappear, except for the sixth, which forms the subclavian artery. A longitudinal anastomosis remains on both sides to form the vertebral artery. Thus, as a rule, the human aortic arch develops in the following way: 1.The left side of the fourth branchial artery forms part of the aortic arch, and the right side forms the beginning of the subclavian artery. 2.Parts of the posterior aortas on both sides atrophy, that is, the area between the third and fourth branchial arteries (left) and the section between the sixth segmental artery and the merged descending aorta (right). 3.The sixth branchial arteries form the beginning of the pulmonary arteries and the ductus arteriosus (Botallo’s duct). The final topographical position of the aortic arch and its branches is a product of differential growth rates of various parts of the arteries, which results in a “migration” and “merging” of branches. The main force behind these changes seems to be the optimization of hemodynamic paths combined with the descending heart. For developmental and general aspects of the aortic arch, see the literature.4–15 Fig. 2.1 Development of the aortic arch. I–VI, occipital segmental branches; C1–C7, cervical segmental branches; T1–T2, thoracic segmental branches; CCA, common carotid artery; ECA, external carotid artery; ICA, internal carotid artery; SA, subclavian artery; VA, vertebral artery. 2.2 “Normal” Situation (70%)
Fig. 2.2 “Normal” situation as given in textbooks (70%). Schematic (a) and MRA, VR 3D image, anterior view (b). 1 Right external carotid artery; 2 left external carotid artery; 3 left internal carotid artery; 4 left common carotid artery; 5 left vertebral artery; 6 left subclavian artery; 7 aorta; 8 right brachiocephalic trunk; 9 right common carotid artery; 10 right subclavian artery; 11 right vertebral artery; 12 right internal carotid artery. Fig. 2.3 Common origin of the right brachiocephalic trunk and left common carotid artery (~13%). Schematic (a) and contrast-enhanced CT images of two patients (b–d). Patient 1: VR 3D image, anterior view (b); MIP at the level of the common origin of the right brachiocephalic trunk and the left common carotid artery, coronal view (c). Patient 2: MIP of the supra-aortic arteries, transverse views (d). Patient with left-sided pleural effusion. 1 Aorta; 2 left subclavian artery; 3 left common carotid artery; 4 right brachiocephalic trunk; 5 right subclavian artery; 6 right common carotid artery. 2.3 Anomalies of the Trunk (23%)
The frequencies of the different types depend largely on the method of examination and racial factors (the types illustrated in Fig 2.3 and Fig 2.4 seem to be present more often in blacks than in Caucasians). Some descriptions are difficult to classify and lie between the types shown in Fig. 2.2, Fig. 2.3, and Fig 2.4. According to the literature, the types shown in Figs. 2.2–2.11 cover approximately 93% of all humans.5,8,14,16–30 Some types that are considered anomalies in humans are the rule in other mammals; for example, Fig 2.4 occurs in rodents and carnivores, Fig 2.5 in insectivores, Fig 2.6 in elephants, and Fig 2.7 in paired and unpaired ungulates. Fig. 2.4 Left common carotid artery originates from the right brachiocephalic trunk (~9%). Schematic (a) and contrast-enhanced CT of the thoracic aorta, VR 3D image, anterior view (b). 1 Right common carotid artery; 2 left common carotid artery; 3 left subclavian artery; 4 aorta; 5 right subclavian artery. Fig. 2.5 Right and left brachiocephalic trunk (<1%). Schematic (a) and MRA, VR 3D image, sagittal oblique view (b). 1 Right brachiocephalic trunk; 2 left brachiocephalic trunk. Fig. 2.6 Trunk formation of both carotid arteries (bicarotid) (<0.1%). Schematic. Fig. 2.7 Common brachiocephalic trunk (<0.1%). Schematic (a) and contrast-enhanced CT of the thoracic aorta, VR 3D image, anterior view (b). The CT image shows the common brachiocephalic trunk in a 24-year-old woman with a truncus arteriosus as a congenital cardiac anomaly. 1 Right subclavian artery; 2 right common carotid artery; 3 left vertebral artery; 4 left common carotid artery; 5 left subclavian artery; 6 common brachiocephalic trunk. Fig. 2.8 Right subclavian artery originates from a bicarotid trunk (<0.1%). Schematic. Fig. 2.9 Left subclavian artery originates from a bicarotid trunk (<0.1%). Schematic. Fig. 2.10 Only a left brachiocephalic trunk (<0.1%). Schematic. Fig. 2.11 No brachiocephalic trunk (<0.1%). Schematic. 2.4 Vertebral Artery as a Direct Branch of the Aortic Arch (4%)
When a segmental artery persists more cranial than the sixth cervical artery, the left vertebral artery will branch from the aortic arch. In such cases, the vertebral artery enters the vertebral column through a more cranial transverse foramen. The vertebral artery can have two origins when the longitudinal anastomosis to the sixth segmental artery remains open. In extremely rare instances, the right vertebral artery originates from the aortic arch. In such cases, either all the beginning part of the right fourth branchial artery forms the aortic arch or there is a variety of the type shown in Section 2.6 with a subsequent “migration” of the origin of the artery.31–33 Fig. 2.12 Left vertebral artery as the penultimate branch of the aortic arch (3%). Schematics of the arterial variation (a), its development (b), and MRA images of the arterial variation (c,d), both of the same patient. MIP of the thoracic aorta and the supra-aortic vessels in an oblique sagittal view (c), VR 3D image in an oblique sagittal view (d). 1 Right vertebral artery; 2 right common carotid artery; 3 left common carotid artery; 4 left subclavian artery; 5 left vertebral artery; 6 right brachiocephalic trunk; 7 aorta. Fig. 2.13 Left vertebral artery as the penultimate branch of the aortic arch; left common carotid artery originating from the brachiocephalic trunk (<1%). Schematic. Fig. 2.14 Left vertebral artery as the last branch of the aortic arch (<1%). Schematic. Fig. 2.15 Left vertebral artery as the last branch of the aortic arch; left common carotid artery originating from the brachiocephalic trunk (<0.1%). Schematic. Fig. 2.16 Left vertebral artery as the last branch of the aortic arch; a common brachiocephalic trunk (<0.1%). Schematic. Fig. 2.17 Vertebral artery branches before the left subclavian artery, but the last branch of the aortic arch is the right subclavian artery (<0.1%). Schematic (a) and MRA, VR 3D image, anterior view (b). 1 Right common carotid artery; 2 right subclavian artery; 3 left common carotid artery; 4 left vertebral artery; 5 left subclavian artery. Fig. 2.18 Two roots of the vertebral artery, one penultimate branch of the aortic arch (<1%). Schematics of the arterial variation (a) and its development (b). Fig. 2.19 Both vertebral arteries directly branch from the aortic arch (<0.1%). Schematic. 2.5 Arteria Thyroidea Ima as a Direct Branch...
