Abstract
Despite progress in ultrasonographic techniques visualisation of the origin of the vertebral arteries, particularly the left, by duplex and colour Doppler imaging, still poses a problem in a significant number of patients. In anatomical and radiological studies we demonstrated an anomalous origin in 6%, the left vertebral artery originating directly from the aorta in most cases. The origin from the subclavian artery was found to be posterior in 44% and inferior in 6%. The V1 segment of the vertebral artery (from its origin to the entry into the foramen transversarium) was tortuous in 47% of cases. These anatomical variants and variations in the course of the vessel contribute to the nonvisualisation of the origin of the vertebral artery by duplex and colour Doppler imaging. With respect to tortuosities technical modifications for better visualisation are suggested and possible implications for surgery are discussed.
Similar content being viewed by others
References
Büdingen HJ, Reutern GM von, Freund HJ (1982) Doppler-sonographie der extrakraniellen Hirnarterien: Grundlagen, Methodik, Fehlermöglichkeiten. Ergebnisse. Thieme, Stuttgart
Ringelstein EB (1984) Ultraschalldiagnostik am vertebrobasilären Kreislauf, Ultraschall Med 5: 215–223
Ringelstein EB, Kolmann HL, Kruse L (1984) Dopplersonographie der extrakraniellen Hirnarterien: in erster Linie ein didaktisches Problem. Ultraschall Med 4: 182–187
Touboul PJ, Bousser MG, LaPlane D, Castaigne P (1986) Duplex scanning of normal vertebral arteries. Stroke 17: 921–923
Bartels E (1991) Duplexsonographie der Vertebralarterien. 1. Teil. Praktische Durchführung, Möglichkeiten und Grenzen der Methode. Ultraschall Med 12: 54–62
Trattnig S, Hübsch P, Schuster H, Pölzleitner D (1990) Colorcoded Doppler imaging of normal vertebral arteries. Stroke 21: 1222–1225
Hutchinson EC, Yates PO (1957) Carotido-vertebral stenosis. Lancet I: 2
Mitchell JRA, Schwarz CJ (1965) Arterial disease. Blackwell, Oxford
Schwartz CJ, Mitchell JRA (1961) Atheroma of the carotid and vertebral artery systems. BMJ 2: 1057–1063
Fisher CM, Gore I, Obake N, White PD (1965) Atherosclerosis of the carotid and vertebral arteries extracranial and intracranial. J Neuropathol Exp Neurol 24: 455
Hagmüller GW (1990) Operationstechnik bei Obliteration im extrakraniellen Abschnitt der A. vertebralis. Angio Arch 19: 20–26
Natali J, Maraval M (1972) Surgical treatment of stenosis and occlusion of the internal carotid and vertebral arteries. J Cardiovasc Surg 13: 4–15
Corning HK (1942) Lehrbuch der topographischen Anatomie, 20/21 edn. Bergmann, Munich
Hafferl A (1969) Lehrbuch der topographischen Anatomie, 3rd edn. Springer, Berlin
Pernkopf E (1952) Topographische Anatomie des Menschen, vol 3. Urban and Schwarzenberg, Vienna
Töndury G (1981) Angewandte und topographische Anatomie des Menschen, 5th edn. Thieme, Stuttgart
Tschabitscher M, Fuss FK, Matula Ch, Klimpel S (1991) Course of the arteria vertebralis in its segment V1 from the origin to its entry into the foramen processus transversi. Acta Anat 140: 373–377
Hauke B (1973) Schlingenbildung der Arteria carotis und Arteria vertebralis. Dtsch Med Wochenschr 98: 2381–2384
Clarisse J, Dobbelaere P, Francke JP, Julliot JP, Jomin M (1977) Superselective injection of the carotid and vertebrobasilar system using a coaxial catheter. J Neuroradiol 4: 5–11
Krayenbühl H, Yarsagil MG (1957) Die vaskulären Erkrankungen im Gebiet der Arteria vertebralis und der Arteria basilaris. Thieme, Stuttgart, p 38
Macke A, Macke-Ribert C (1977) L'artère carotide interne. Étude anatomique et microradiographique, Exploration endoluminale. Medical thesis, University of Lille
Wuttke V, Schmitt R, Pogan J, Clar HE (1990) Cervical nerve root compression syndrome caused by the vertebral artery. RÖFO 152: 473–474
Glover JR, Kennedy C, Coral A (1990) Tortuous vertebral artery-onset of symptoms during pregnancy. Clin Radiol 41: 66–68
Salvador MR, Solé-Llenas J, Quera-Salva MA (1981) Bilateral bone erosion of the cervical vertebrae caused by tortuosity of the vertebral arteries. Neurochirurgia 24: 212–213
Gabella JL, Thiébot J, Houdent G, Léonard A, Le-leot X, Deshayes P (1981) Cervical bone erosion by a loop of the vertebral artery. Rev Rhum Mal Osteoartic 48: 277–279
Beranek L (1984) Erosion of cervical intervertebral foramen by a buckle of the vertebral artery. Rev Rhum Mal Osteoartic 51: 439
Palmer FJ, Sequiera M (1980) Cervical vertebral erosion and vertebral artery tortuosity: an angiographic study. Australas Radiol 24: 20–23
Freilich M, Virapongse C, Kier EL, Sarwar M, Bhimani S (1986) Foramen transversarium enlargement due to tortuosity of the vertebral artery. Computed tomographic appearance. Spine 11: 95–98
Nishijima M, Harada J, Nogami K, Endo S, Takaku A (1989) Operative correction of kinking and coiling at the origin of vertebral artery and stellate ganglionectomy. No-Shinkei-Geka 17: 255–261
Poindexter JM, Patel K, Clauss RH (1987) Management of kinked extracranial cerebral arteries. J Vasc Surg 6: 127–133
Nishijima M, Harada J, Akai T, Endo S, Takaku A (1989) Operative correction of a kinked duplicate origin of the vertebral artery in a patient with dizziness. Case report. Surg Neurol 32: 356–359
Argenson C, Francke JP (1980) The vertebral arteries (segments V1 and V2). Anat Clin 2: 29–41
Sakamoto H (1980) A case of right vertebral artery as the last branch of the aortic arch. Kaibogaku Zasshi 55: 503–508
Cadaver S, Arisan E (1989) Variations in the extracranial origin of the human vertebral artery. Acta Anat 135: 236–238
Schwarzbacher SW, Krammer EB (1989) Complex anomalies of the human aortic arch system: unique case with both vertebral arteries as additional branches of the aortic arch. Anat Rec 225: 246–250
Padget DH (1964) Designation of the embryonic intersegmental arteries in reference to the vertebral artery and subclavian stem. Anat Rec 119: 349–356
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Trattnig, S., Matula, C., Karnel, F. et al. Difficulties in examination of the origin of the vertebral artery by duplex and colour-coded Doppler sonography: anatomical considerations. Neuroradiology 35, 296–299 (1993). https://doi.org/10.1007/BF00602620
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00602620