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Retrospective Computed Tomography Angiogram Investigation on the Subclavian Artery Branching Pattern and Origin
Author(s) -
Ryu Juwan,
Scallan Oonagh,
Johnson Marjorie,
Wilson Tim,
Power Adam
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.557.1
Subject(s) - medicine , subclavian artery , radiology , branching (polymer chemistry) , computed tomography , computed tomography angiography , anatomy , aorta , nuclear medicine , cardiology , composite material , materials science
Intro The subclavian artery (SCA) is a substantial vessel with several branches and therefore potential branching patterns. Knowledge of the subclavian artery and its associated branches is important in vascular surgeries of the upper extremity and aorta in order to avoid bleeding and injury. Typical branching order off the SCA is Vertebral (VA), Internal Thoracic (ITA), Thyrocervical (TCT), Costocervical (CCT) and Dorsal Scapular Artery (DSA), however, significant variations to this traditional understanding may exist. The purpose of this study is to characterize the variations in the origin and branching pattern of SCA branches using measurements from patient Computed Tomography Angiograms (CTAs). Methods Head & neck and upper limb CTAs from 55 patients (bilaterally, 110 scans) were retrospectively reviewed on 3D visualizing software TeraRecon. Of these, 101 CTAs displaying left (n=49) and right (n=52) SCAs of sufficient resolution and clarity were selected. Measurements were taken of the distance at which SCA branches originated from the aorta using the software's distance measuring tool and manually tracing the path of SCA to each branch origin. Also, the number of branches and their respective order were counted. Results Five branches originated directly from the SCA with the highest frequency: VA (97.0%), ITA (91.1%), TCT (90.1%), CCT (77.2%), and DSA (57.4%). Only 13 SCAs (12.9%) were observed to have exhibited the typical pattern. VA originated first in 80.2% of SCAs, with ITA arising second (41.3%), TCT as third (47.3%), CCT as fourth (43.6%) and DSA as the fifth branch (56.9%). Common aberrant branches that arose directly from the SCA were Ascending Cervical (4.9%), Deep Cervical (9.9%), Inferior Thyroid (7.9%) and Supreme Intercostal Artery (8.9%). Discussion The subclavian artery branching order and pattern may present significant variation from the typical order. Our findings demonstrate that, within our sample, ITA and TCT arise 2nd (41.1%) and 3rd (46.9%), respectively. These arteries may frequently swap in order for ITA to originate 3rd (32.6%), and TCT to originate 2nd (31.9%). However, VA reliably originates as the most proximal branch (80.2%). The variability in subclavian artery branching pattern poses a challenge in subclavian artery surgery such as SCA‐Common Carotid Artery bypass and transposition. The findings of this study will be used to define the optimal patient position for safe and maximal exposure of the SCA in the supraclavicular surgical window.