颈总动脉高位分叉伴颈外动脉分支多处变异一例

在解剖一成年女性尸体时,见其左侧颈总动脉高位分叉,伴颈外动脉分支多处异常,而右侧正常.现分述如下.     

肝总动脉分支变异一例

作者于１９９８年作腹部标本时发现一例肝总动脉分支的变异。该肝总动脉从腹腔于发出后隔网膜囊向右走行在胃后方,而后在近胃窦部上方从左至右依次发出１支肝左动脉,２支肝右动脉及１支胃十二指肠动脉。从肝左动脉发出１支胃右动脉。两支肝右动脉均行于门静脉前方并与之成锐角。左侧肝右动脉继而行经肝总管的前方进入胆囊三角,在此发出１支胆囊动脉浅支。右侧肝右动脉则经胆总管前方绕过胆囊的后方,在此发出１支胆囊动脉深支后径胆囊管的后方进入肝右叶。此种肝总动脉分支的变异给肝胆外科的手术操作及肝的动脉造影增加了难度。故对临床…     

中国小儿无名动脉与颈总动脉及其分支的研究

本文调查了76例(♂44,♀32)1、2和3岁中国小儿无名动脉和颈总动脉的位置、长度、周径、分支部位和分支型。1.76例小儿无名动脉与气管的位置关系,共分三型:第1型2例(2.63±1.84%);第2型33例(43.42±5.72%),第3型41例(53.95±5.71%)。2.76例小儿无名动脉分支部位,在胸锁关节上缘上方者57例(75.0±4.96%),在胸锁关节后方者19例(25.0±4.96%),小儿较成年人高。 3.76例1、2和3岁小儿无名动脉平均长度分别为20.7±0.42毫米、19.2±0.56毫米和21.8±0.94毫米。平均周径分别为19.8±0.64毫米、20.3±0.21毫米和21.0±0.51毫米。4.76例小儿无名动脉有63例(82.9±4.32%)单独由主动脉弓发出;另外13例(17.1±4.32%)与左颈总动脉先形成共同干而后发出。在76例无名动脉中,有71例(93.42±2.84%)在走行中并不发支,但有4例(5.26±2.56%)直接由无名动脉发出甲状腺最下动脉,有1例(1.32±1.31%)由共同干发出甲状腺最下动脉。5.小儿颈总动脉的分支部位平均位于第3、4颈椎椎间盘上缘高度,小儿较成年人高。6.颈总动脉分支所形成的夹角,共分三型,在152侧中锐角型60侧(39.5±3.96%);弓状型40侧(26.3±3.57%);中间型52侧(34.2±3.84%),小儿锐角型较多于弓状型。7.1、2和3岁中国小儿颈总动脉平均长度:右侧分别为42.9±1.55毫米、45.7±0.57毫米和47.8±1.50毫米;左侧分别为59.0±1.10毫米、56.7±2.99毫米和64.9±1.62毫米。平均周径:右侧分别为14.8±0.77毫米、16.3±0.14毫米和16.6±0.19毫米。左侧分别为15.6±0.61毫米、16.6±0.13毫米和17.3±0.40毫米。     

肝总动脉分支变异1例

肝固有动脉起点变异的情况临床比较常见，多见于肝固有动脉与胃左动脉共干或肝固有动脉起自于肠系膜上动脉，或有起源不同的两支肝固有动脉。作者应用解剖制作标本过程中发现一例肝总动脉末端呈三叉型发出肝左动脉、肝右动脉和胃十二指肠动脉，并无肝固有动脉，同时肝左动脉在近起点处发出细小肝副左动脉与肝左动脉平行进入肝左叶。     

肝总动脉分支变异1例

作者在解剖1具成年男性尸体标本时,发现其肝总动脉起始部分出一粗大动脉,进而分出胰十二指肠上动脉和左结肠动脉,现报道如下     

髂外动脉、股动脉、腘动脉及其分支的变异*

随着解剖学的不断发展,了解动脉变异可为临床工作提供重要参考依据,故笔者查阅相关变异文献资料,归纳、整理出髂外动脉、股动脉、腘动脉及其分支的多种变异类型供于参考. 1 数据来源 1999年到2020年,知网和万方数据库所收录的,有关髂外动脉、股动脉、腘动脉变异的文章.     

锁骨下动脉起始及分支变异*

关于锁骨下动脉的变异,尤其是分支类型国内已有多篇文献报道,但各文献的分类标准不统一,分型数量也不尽相同.尚未有对锁骨下动脉变异较为全面系统的描述.通过万方数据和中国知网数据库,现对锁骨下动脉变异文献资料进行归纳、整理和统计,获得了相关的参考数据.     

颈总动脉及其分支与锁骨下动脉异常4例

<正>在教学中发现颈总动脉及其分支与锁骨下动脉走行异常。例1:中年男尸,右侧颈内动脉在起始处返折,呈横置的"U"字形,舌动脉与面动脉共干发自颈外动脉,舌动脉在面动脉的下方,先向后上再向前下螺旋走行,最后斜上走行,整体呈"V"字形。面动脉自舌动脉下方发出后绕经舌动脉的前面向后上方行走。颈总动脉上部和颈内动脉在颈动脉鞘内位于颈内静脉的前方(图1a)。颈总动脉中段与颈内静脉呈内外平行走行,颈总动脉下部位于颈内静脉后方,颈动脉小球位于颈外动脉后方(图1b)。     

腋动脉和肱动脉及其分支变异

随着精准化医学的进一步发展,临床上更应注重血管的走向,腋动脉及肱动脉的分支类型差异较大,国内、外类型皆不相同.现针对国内现有的文献资料,对中国国人腋动脉、肱动脉的分段、分支、分型进行统计汇总,以减少临床上个体差异带来的影响.     

The diameters of common carotid artery and its branches in newborns

The common carotid artery (CCA) bifurcation is of clinical importance due to its vascular access site for intravascular intervention. Additionally, it is also one of the most common sites of atherosclerotic plaque formation. There are numerous studies on the diameters of CCA, internal carotid artery (ICA), and external carotid artery (ECA) in adults, but few studies on newborns. Cadaver and angiographic studies have shown dimensional variations in the carotid arteries within/between individuals and also between different sexes. It is well known that the initial lesions of atherosclerosis begin very early in fetal life. Therefore, it is important to know the anatomical details of the CCA and its branches. In the present study, the neck regions of 20 (11 males and 9 females) fixed newborn cadavers were dissected. The CCAs were cut below the bulb of the carotid bifurcation further; ICA and ECA were cut above the bulb of the carotid bifurcation. The internal diameters of the CCA, ICA, and ECA were measured using a light microscopy. ECA/CCA, ICA/CCA, ICA/ECA ratios, and outflow to inflow area ratio were calculated. The mean outflow to inflow area ratio was 1.14±0.28. Our results highly correlated with the defined optimal ratio (1.15). The ECA/CCA, ICA/CCA, and ICA/ECA ratios were 0.78±0.12, 0.71±0.13, and 0.93±0.16, respectively. There were no statistically significant differences between male and female and also between right and left sides. These findings are of importance in understanding the anatomy of carotid artery during newborn period.     

Investigation of the bifurcation level of the common carotid artery and variations of the branches of the external carotid artery in human fetuses.

Variations in the position of the bifurcation of the common carotid artery (CCA) and the origin or branching pattern of the external carotid artery (ECA) are well known and documented. In this study, the bifurcation levels of the CCA and origin variations of the branches of the ECA have been extensively investigated in human fetuses. Bilaterally, 40 carotid bifurcations and 40 ECA and their branches have been examined. A latex solution, which had been diluted with water at a ratio of 25% and colored with red India ink, was injected into the aortic arch. Fetuses were kept at room temperature for 24 h before the ECA and its branches were dissected under the microsurgery microscope. Cases of variation were determined and photographed. The bifurcation level of the CCA was determined to be 55% at the C3 level, 35% at the C4 level, 10% at the C5 level on the right side and 60% at the C3 level, 40% at the C4 level on left side. The distribution of the ECA trunks was determined as follows: A linguofacial trunk was present in 20% of the cases, a thyrolingual trunk in 2.5%, a thyrolinguofacial trunk in 2.5% and an occipitoauricular trunk in 12.5%. Beyond this the ascending pharyngeal artery (APA) was observed in one fetus to originate from the internal carotid artery (ICA). Knowledge of variations in the origin and course of the ECA and its branches is of great importance in surgery and radiological examinations.     

腋动脉分支变异1例

我们在解剖一具老年男性标本时,发现其左侧腋动脉分支变异(图1),现报道如下:左侧腋动脉长8.90 cm,起始口径为6.85 mm,经正中神经内侧根的前面下行,于大圆肌腱下缘延续为肱动脉(中段外径3.74mm).该侧腋动脉在第二段外下缘发出一变异动脉干(长4.41cm,起始外径5.30 mm).该动脉干从正中神经内、外侧根之间穿过后行向外下,分为内、外2个分支:(1)内侧支为变异肩胛下动脉,长2.03 cm,起始外径为4.11mm.该动脉沿肩胛下肌下缘行向内下方,除了发出正常行程的旋肩胛动脉和胸背动脉外,还在距起点0.64 cm处发出肌支至肩胛下肌(起始外径为1.05 mm).     

Variation of the origin of the left common carotid artery diagnosed by CT angiography

Introduction

The left common carotid artery (LCCA) is usually a second branch of the aortic arch that arises between the brachiocephalic trunk (BCT) and left subclavian artery; relatively frequently, it also arises from or shares a common origin with the BCT. In patients with LCCA of anomalous origin, transfemoral catheterization into the LCCA is sometimes difficult, and transbrachial or transradial approach may be recommended. We evaluated the prevalence of these variations on computed tomography (CT) angiography.

Methods

We retrospectively reviewed CT angiographic images of 2,357 patients obtained using either of two 64-slice multidetector CT scanners. All patients were Japanese and underwent scanning from the aortic arch to the intracranial region; most had or were suspected of having cerebrovascular diseases.

Results

We evaluated CT angiographic images of 2,352 patients after excluding four patients with LCCA occluded at its origin. The LCCA arose from the BCT in 141 patients (6.0 %) and had a common origin with the BCT in 130 patients (5.5 %). We found 11 aberrant right subclavian artery (0.47 %), and four of the 11 patients (36 %) had LCCA of common origin with the right common carotid artery, forming a bicarotid trunk (prevalence: 0.17 %).

Conclusions

The total prevalence of variations of LCCA origin diagnosed by CT angiography was 11.7 %.     

Intracavernous branches of the internal carotid artery (ICA)

Summary Since we started to work in the lateral sellar region (in 1973), a large volume of angiographic material has provided us with exceptional variations that added to the anatomic facts obtained from our dissections. At present, these anatomic facts remain, but the way we look at them and the way we use them for endovascular treatments, has created a need for a different type of approach and understanding.In this report, we present a flexible anatomical view of the intracavernous branches of the internal carotid artery and a scheme to understand and predict the anatomical variations of these collaterals. Four embryonic vessels play an important role in the variations of the arterial supply to the lateral cavernous region: the dorsal ophthalmic artery, the stapedial artery, the trigeminal artery and the primitive maxillary artery. In general each of them partially regresses leaving behind a remnant. However there is a spectrum from their persistence to incomplete regression, resulting in variations of the supply to their distal territories. The term meningohypophyseal should be abandoned because it is misleading and improperly used.Complete agenesis is known for a long time; in case of segmental agenesis of the ICA each of the embryonic vessels presented above may represent an alternate route to bypass the agenesis. The ICA is not a direct feeding artery but a succession of independant segments which can be the site of various anomalies. An embryonic transdural circle can be individualized; it is constituted by the trigeminal arteries posteriorly, the ICA siphon anteriorly, the transsellar anastomosis and internal maxillary artery connections. Although regressions usually occur in this embryonic transdural circle, its derivatives congenital and acquired arterial pathologies. It also constitutes the key system in determining the arterial variations of the perisellar region.

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Collatérales intra-caverneuses de la carotide interne:Synthèse de leurs variations

Résumé Depuis que nous avons commencé notre travail, sur la région latéro-sellaire (en 1973), une grande quantité d'angiographies sélectives de variations vasculaires est venue compléter le matériel anatomique que nous avions obtenu à partir des dissections. Aujourd'hui les faits anatomiques observés restent, mais la faÇon dont nous les regardons et la manière dont nous les utilisons pour nos traitements endovasculaires nécessitent une vision et une présentation différente de ces variétés.Dans cet article, nous proposons une vision anatomique « flexible » des branches intra-caverneuses de la carotide interne à partir d'un schéma générique permettant de comprendre et de prédire les variations de ces collatérales. 4 vaisseaux embryonnaires jouent un rÔle clé dans le déterminisme des variations artérielles de cette région: l'artère ophtalmique dorsale, l'artère stapédienne, l'artère trijéminée et l'artère maxillaire primitive. En général, chacune d'entre elles régresse partiellement, laissant derrière elle un reliquat artériel. En fait, il existe toute une gamme possible, entre la persistance du vaisseau embryonnaire et le reliquat; chacun de ces intermédiaires, crée une variation dans le territoire de vascularisation de ces artères. Ainsi le terme de tronc méningo-hypophysaire devrait Être abandonné car il est source de confusion et utilisé la plupart du temps de faÇon anatomiquement impropre.De mÊme, l'agénésie complète de la carotide interne est connue depuis longtemps; mais en cas d'agénésie incomplète de la carotide interne chacun des vaisseaux embryonnaires présentés ci-dessus constitue une voie de suppléance, court-circuitant le segment agénatique. La carotide interne ne doit pas Être considérée comme une artère nourricière proprement dite mais comme une succession de segments indépendants pouvant Être le siège d'anomalies multiples mais spécifiques. Enfin, on peut donc décrire, un cercle embryonnaire trans-dural constitué par les artères trijéminées en arrière, les siphons carotidiens en avant, l'anastomose trans-sellaire sur la ligne médiane et les anastomoses maxillaires internes en dehors. Bien que chacun des éléments de ce cercle embryonnaire régresse au cours du développement, ces reliquats constituent en pratique des voies accessoires fournissant la circulation collatérale efficace aussi bien dans les anomalies congénitales qu'acquises du tronc artériel carotidien interne. Ce cercle artériel embryonnaire constitue le système clé du déterminisme des variétés artérielles de la région péri-sellaire, ses variétés sont indépendantes de celles du cercle de Willis.

     

Absence of the right common carotid artery

In a 33-year-old male patient with multiple sclerosis, brain magnetic resonance imaging incidentally showed a narrow right intracranial internal carotid artery. Gadolinium-enhanced magnetic resonance angiography showed absence of the right common carotid artery. Right external and internal carotid arteries arose separately from the ipsilateral innominate artery and subclavian artery, respectively. Color-Doppler ultrasound confirmed this finding. Embriologically, the case could be interpreted as the disappearance of the third aortic arch with persistence of the carotid duct connecting the third and fourth aortic arches.