Common Origins of Carotid and Subclavian Arterial Systems: Report of a Rare Aortic Arch Variant

doi:10.1007/s10016-004-0060-3

Annals of Vascular Surgery

Volume 18, Issue 5, September 2004, Pages 597-600

https://doi.org/10.1007/s10016-004-0060-3 Get rights and content

An aberrant right subclavian artery (aSA) arising from the proximal descending aorta is one of the most common anomalies of the aortic arch. We present our experience with an asymptomatic atypical aSA variant found during routine anatomic dissection. This aortic arch variant had two branches, the first being a bicarotid trunk and the second being a common trunk for both subclavian arteries. The right subclavian artery traveled behind the esophagus to reach the right upper extremity, thus forming an incomplete vascular ring around the trachea and the esophagus. The literature has been silent about the existence of this exact aSA variation. A plausible embryologic explanation is provided. An aSA is rarely symptomatic, but when symptoms do occur and intervention is warranted, it is important for surgeons and radiologists alike to be aware of the vascular anomalies that may potentially coexist with this entity. The surgical and endovascular options associated with this unique vascular anomaly are also discussed.

Section snippets

CASE REPORT

An unusual aortic arch branching pattern was found in a 77-year-old male cadaver during routine dissection at the Department of Anatomy, University of Athens School of Medicine. This left-sided aortic arch was found to have only two branches rather than the usual three. The first was a common trunk giving origin to the common carotid arteries. This bicarotid trunk, 1.2 cm in length and 1.8 cm in diameter, arose 7.2 cm distal to the origin of the right coronary artery. Nine millimeters distally

DISCUSSION

To appreciate the altered arrangement of the anatomic structures described above, it might help to briefly review the prevailing viewpoints concerning the embryological basis of their appearance. In the embryo, there are six pairs of primitive aortic arches, one for each brachial cleft (Fig. 2). Among those, the third and fourth pairs are associated with the development of the aortic arch system. The third pair of cervical aortic arches gives rise to the left and right common carotid arteries.

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As observed in the current patient, the second most common type of great vessel branching is observed in between 10% and 27% of individuals and is characterized by a common brachiocephalic trunk-left carotid artery origin followed by the left subclavian artery.1,2,4–9 A third type of branching, which includes a separate origin of the left vertebral artery from the aortic arch, has been reported in 2.5%-8% of individuals,7 whereas a wide variety of other branching patterns also exist, all of which occur in less than 2% of the population.7,10,11 TEE visualization of the major aortic arch branches most often is not possible because of tracheal interposition (“blind spot”) that prevents examination of the distal ascending thoracic aorta and proximal to the midaortic arch.12–14
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Common Origins of Carotid and Subclavian Arterial Systems: Report of a Rare Aortic Arch Variant

Section snippets

CASE REPORT

DISCUSSION

J. Vasc. Surg.

J. Vasc. Surg.

Ann. Vasc. Surg.

Ann. Vasc. Surg.

J. Vasc. Surg.

Clin. Radiol.

J. Vasc. Surg.

Examen de quelques parties d'un singe

Hist. Acad. R. Sci.