• Journal of Cardiovascular Imaging
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• v.30 no.4
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• pp.231-262
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• 2022

There is a wide spectrum of congenital anomalies or variations of the aortic arch, ranging from non-symptomatic variations that are mostly detected incidentally to clinically symptomatic variations that cause severe respiratory distress or esophageal compression. Some of these may be accompanied by other congenital heart diseases or chromosomal anomalies. The widespread use of multidetector computed tomography (CT) in clinical practice has resulted in incidental detection of several variations of the aortic arch in adults. Thus, radiologists and clinicians should be aware of the classification of aortic arch anomalies and carefully look for imaging features associated with a high risk of clinical symptoms. Understanding the embryological development of the aortic arch aids in the classification of various subtypes of aortic arch anomalies and variants. For accurate diagnosis and precise evaluation of aortic arch anomalies, cross-sectional imaging modalities, such as multidetector CT or magnetic resonance imaging, play an important role by providing three-dimensional reconstructed images. In this review, we describe the embryological development of the thoracic aorta and discuss variations and anomalies of the aortic arch along with their clinical implications.

• Journal of the Korean Society of Radiology
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• v.82 no.3
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• pp.743-748
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• 2021

Various anomalous origins of the vertebral arteries (VAs) have been reported. However, anomalous origins of the bilateral VAs arising directly from the aortic arch are extremely rare. We encountered a 60-year-old male who developed sudden-onset right hemiparesis with an incidentally discovered rare origins of the bilateral VAs from aortic arch. CT angiography demonstratedt he right VA originating from the aortic arch distal to the left subclavian artery and left VA originating from the aortic arch between the left common carotid artery and the left subclavian artery. The possible embryological mechanism of this variant was also reviewed. If the VA can not be found in the usual position during the procedure, a rare variant of the VA with anomalous origin should be considered. Understanding these variations is important to avoid unexpected events during endovascular procedures or surgery.

• Journal of the Korean Society of Radiology
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• v.84 no.1
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• pp.286-290
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• 2023

Various branch anomalies of the aortic arch have been reported, but cases with separate origins of the internal and external carotid arteries with combined direct aortic arch origin of the left vertebral artery are extremely rare. Herein, we present a rare case of aplasia of the left common carotid artery with separate origins of the ipsilateral internal and external carotid arteries and vertebral artery from the aortic arch in a 10-year-old girl. In addition, we review the embryological development and clinical implications of these anatomical variations.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.1
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• pp.65-70
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• 2024

We present a case of intracranial aneurysm located in the P1 segment of left posterior cerebral artery in the context of tetralogy of Fallot. Complex variations included right aortic arch with abnormal branching. Also, the bilateral vertebral arteries were absent, with a type I persistent proatlantal intersegmental artery of the left side. The aneurysm was treated with endovascular intervention with a Tubridge flow diverter and was noted to be completely cured on 6-month follow-up. We discuss the many considerations in this patient including developmental and modern-era treatment.

• Journal of Korean Neurosurgical Society
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• v.44 no.2
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• pp.78-83
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• 2008

Objective : To understand the anatomic characteristics of the aortic arch (AA) and its major branches to build a foundation toward performing endovascular surgery safely. Methods : A total of 25 formalin fixed Korean adult cadavers were used. The authors investigated : anatomical variations of the AA and its major branches; curvature of the AA; distance from the mid-vertebrae line to the origin of the major branches; distances from the origin of the major branches of AA to the origin of its distal branches; and the angle of the three major branches, the brachiocephalic trunk (BCT), the left common carotid artery (LCCA) and the left subclavian artery (LSCA) arising from AA. Results : The three major branches directly originated from AA in 21 (84%) of the cadavers. In two (8%) of remaining four cadavers. orifice of LCCA was slightly above the stem of BCT. In remaining two (8%) cadavers, the left vertebral artery (LVA) was directly originated from AA. Average angle of AA curvature to the coronal plane was 62.2 degrees. BCT originated 0.92 mm on the right of the mid-vertebrae line. LCCA and LSCA originated from 12.3 mm and 22.8 mm on the left of the mid-vertebrae line. Mean distance from the origin of the BCT to the origin of the RCCA was 32.5 mm. Mean distance from the origin of the LSCA to the origin of the LVA was 33.8 mm. Average angles at which the major branches arise from the AA were 65.3, 46.9 and 63.8 degrees. Conclusion : This study may provides a basic anatomical information to catheterize AA and its branches for safely performing endovascular surgery.

• Korean Journal of Head & Neck Oncology
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• v.22 no.1
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• pp.3-7
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• 2006

Purpose: The nonrecurrent laryngeal nerve(NRLN) is a rare anomaly that is associated with the developmentally aberrant subclavian artery. Although rare on the right side and exceptional on the left, an aberrant nonrecurrent pathway for RLN represents a major surgical risk. Three course variations of right NRLN can be distinguished: descending(type I) , horizontal(type II), ascending(type III). This study is performed to characterize the variations of NRLN, associated vascular anomaly, and proper surgical methods for preventing nerve damage. Materials and Methods: Between January 1998 and March 2006 3,381 thyroidectomy were performed at our institution, and during these operations a nonrecurrent laryngeal nerve was observed in 13 cases (0.38%). There were 1 men and 12 women with a median age of 48 years(range 28-57). All of them are identified on the right side. Results: In all cases, there were no clinical symptoms observed preoperatively. The nerve anomaly was diagnosed preoperatively in only one case. There were type I variations of right RLN in 2 cases and type II variations in 11 cases. The retroesophageal aberrant right subcalvian artery; no innominate(brachiocephalic) artery was found and the right common carotic artery was arising directly from the aortic arch, was seen in 12 cases. A vocal cord palaysis caused by NRLN damage during operation was observed in one patient(7.6%) , where the nerve was close to the superior thyroid artery. No other complications were noted. Conclusion: It can be possible to predict NRLN from signs associated with the vascular anomaly; clinical symptoms or imaging studies. When an vascular anomaly is not detected preoperatively, overlooking possibility of NRLN may lead to severe operative morbidity. Hence, It is most important to identify all the thyroid structures carefully during thyroid surgery and to be aware of the possibility of anatomic variations of RLN.