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Subclavian Artery Branch Variability based on Computed Tomography Angiography

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Subclavian Artery Branch Variation based on Computed Tomography Angiography 

INTRODUCTION

  • Anatomical textbooks classically describe five branches from the subclavian artery (SCA). Vertebral artery (VA), internal thoracic artery (ITA), and thyrocervical trunk (TCT) originate from the first part, and costocervical trunk (CCT) originates from the second part. Dorsal scapular artery (DSA) arises from the second or third part. (Figure 1)

  • The first, second, and third parts of the SCA are proximal, posterior, and distal to the anterior scalene muscle (ASM).

  • It is well documented that there is variaHon of SCA vessels; atypical common trunks and anomalous origins have been reported and are briefly summarized in Table 1.

  • There is limited literature characterizing the branching paUerns and locaHon of these branches along the SCA; many studies focus on a single artery and are cadaveric studies.

  • A precise understanding of subclavian anatomy and variaHons is important to radiologists and vascular surgeons for diagnosHc and intervenHonal purposes. 

PURPOSE

• To enhance current knowledge of the branching paUern of the subclavian artery using computed tomography angiography (CTA) 

METHODS

  • All upper limb and selected head and neck CTAs performed at LHSC from January 2008 to 2015 were reviewed. 74 CTAs were reviewed in total.

  • 55 CTAs showing 101 subclavian artery vessels in 55 paHents were of sufficient resoluHon to determine anatomy

  • The software program Intuiton (TeraRecon) was used to calculate several measurements:

    •  Number and idenHficaHon of vessels branching from SCA

    •  PosiHon of each branch on the subclavian artery relaHve to ASM

    •  Distance from the aorta to each branch origin 

RESULTS

  • 15 subclavian arteries (14.9%) were found to have all five typical branches present in the the standard reported order of VA, ITA, TCT, CCT, DSA.

  • The vertebral artery is the most consistent vessel and originates from the first part of SCA in 96.7%, with 3.3% (n=3) arising from the aorta, similar to previous reports in literature. (Table 3) It is the first branch from SCA in 82% of CTAs.

  • ITA also demonstrated consistency and arose from SCA in 91.1%. Variants seen were common trunks with TCT (6.9%) or suprascapular artery (1.0%).

  • The more distal vessels originate from SCA less frequently, and were seen branching off of other vessels or were absent.

  • CCT was idenHfied as originaHng from the first part of subclavian in the majority of CTAs (69.4%) and was only seen in the second part 16.7% of the Hme. (Table 3)

  • The most frequent aberrant vessels were individual branches of CCT or TCT, or common trunks of vessels. An accessory vertebral artery was idenHfied in one CTA. 

CONCLUSIONS

  • The branching pattern of the subclavian artery is highly variable, more than traditionally described in anatomical text books.

  • VA and ITA, two clinically important vessels, were found to be generally consistent. More variability was seen in vessels that originate distally on SCA.

  • Knowledge of the specific branching paUerns and variaHon is criHcal for vascular intervenHonalists when treaHng upper extremity vascular disease, such as subclavian artery stenHng. 

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