Normally, the arch sidedness is towards the left, and there is no arterial duct behind the trachea or esophagus. A DAA is when there are two transverse aortic arches running over the trachea and both bronchi. A left aortic arch would be towards the left of the trachea and run over the left bronchus, whereas an RAA would be towards the right of the trachea and run over the right bronchus. Īn arch sidedness is defined by the position of the aortic arch in relation to the trachea and the bronchi. It usually includes aberrant innominate artery, aberrant right subclavian artery, and pulmonary artery sling. Incomplete VRs do not completely encircle the trachea and esophagus, although some compress either the trachea or esophagus. These include a double aortic arch (DAA) and a right aortic arch (RAA) with an aberrant (retro-esophageal) left subclavian artery. These are the most common types of vascular rings. VRs are further divided into two broad categories: complete or incomplete.Ĭomplete VRs encircle the trachea and esophagus entirely. The term "vascular ring" (VR) refers to the vascular structures that encircle and compress the esophagus and trachea, causing respiratory and gastrointestinal symptoms.
Identify the embryology of vascular rings causing a double aortic arch and a right aortic arch with aberrant left subclavian artery.This activity reviews the evaluation and management of vascular rings and explains the role of the interprofessional team in managing patients with this condition. The most common aortic arch association with a vascular ring is a DAA or a right aortic arch with an aberrant (retro-esophageal) left subclavian artery. There is a patent vessel, an atretic vessel, or its remnants circling the trachea or esophagus in cases of the vascular ring. Normally, the arch sidedness is towards the left, and there is no arterial duct behind the trachea or esophagus. A double aortic arch (DAA) occurs when there are two transverse aortic arches running over the trachea and both bronchi. A left aortic arch (LAA) would be on the left of the trachea and run over the left bronchus, whereas a right aortic arch (RAA) would be on the right of the trachea and run over the right bronchus. An arch sidedness is defined by the position of the aortic arch in relation to the trachea and bronchi. It can be further classified based on the location of the aortic arch. © 2017Wiley Periodicals, Inc.ĪCDF aberrant anatomy anomaly complications iatrogenic injury spine surgery variant vasculature.The term "vascular ring" refers to the vascular structures that encircle and compress the trachea and esophagus, causing respiratory and gastrointestinal symptoms.
Spine surgeons who approach the anterior cervical spine should be aware that an aortic origin of the left vertebral artery is likely to be closer to the midline and less protected above the C6 vertebral level. Of all cases, vertebral arteries that arose from the aortic arch were much more likely to not only have a more medial course (especially their preforaminal segment) over the cervical vertebral bodies but also to enter a transverse foramen that was more cranially located than the normal C6 entrance of the vertebral artery. The retrospective radiological database analysis identified 13 cases (0.87%) of left vertebral artery origin from the aortic arch. Two cadaveric specimens (4%) were found to have a left vertebral artery arising from the aortic arch. Additionally, two radiological databases of CTA and arteriography procedures were retrospectively examined for cases of aberrant left vertebral artery origin from the aortic arch over a two-year period. Fifty human adult cadavers were examined for left vertebral arteries having an aortic arch origin and these were dissected along their entire cervical course. We hypothesized that left vertebral arteries that arise from the aortic arch instead of the subclavian artery might take a more medial path in their ascent making them more susceptible to iatrogenic injury. However, variant anatomy might predispose one to an increased incidence of injury during such procedures. Complications from anterior approaches to the cervical spine are uncommon with normal anatomy.
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