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Difficulties in examination of the origin of the vertebral artery by duplex and colour-coded Doppler sonography: anatomical considerations

  • Diagnostic Neuroradiology (Brain)
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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.

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References

  1. Büdingen HJ, Reutern GM von, Freund HJ (1982) Doppler-sonographie der extrakraniellen Hirnarterien: Grundlagen, Methodik, Fehlermöglichkeiten. Ergebnisse. Thieme, Stuttgart

    Google Scholar 

  2. Ringelstein EB (1984) Ultraschalldiagnostik am vertebrobasilären Kreislauf, Ultraschall Med 5: 215–223

    Google Scholar 

  3. Ringelstein EB, Kolmann HL, Kruse L (1984) Dopplersonographie der extrakraniellen Hirnarterien: in erster Linie ein didaktisches Problem. Ultraschall Med 4: 182–187

    Google Scholar 

  4. Touboul PJ, Bousser MG, LaPlane D, Castaigne P (1986) Duplex scanning of normal vertebral arteries. Stroke 17: 921–923

    Google Scholar 

  5. Bartels E (1991) Duplexsonographie der Vertebralarterien. 1. Teil. Praktische Durchführung, Möglichkeiten und Grenzen der Methode. Ultraschall Med 12: 54–62

    Google Scholar 

  6. Trattnig S, Hübsch P, Schuster H, Pölzleitner D (1990) Colorcoded Doppler imaging of normal vertebral arteries. Stroke 21: 1222–1225

    Google Scholar 

  7. Hutchinson EC, Yates PO (1957) Carotido-vertebral stenosis. Lancet I: 2

    Google Scholar 

  8. Mitchell JRA, Schwarz CJ (1965) Arterial disease. Blackwell, Oxford

    Google Scholar 

  9. Schwartz CJ, Mitchell JRA (1961) Atheroma of the carotid and vertebral artery systems. BMJ 2: 1057–1063

    Google Scholar 

  10. 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

    Google Scholar 

  11. Hagmüller GW (1990) Operationstechnik bei Obliteration im extrakraniellen Abschnitt der A. vertebralis. Angio Arch 19: 20–26

    Google Scholar 

  12. Natali J, Maraval M (1972) Surgical treatment of stenosis and occlusion of the internal carotid and vertebral arteries. J Cardiovasc Surg 13: 4–15

    Google Scholar 

  13. Corning HK (1942) Lehrbuch der topographischen Anatomie, 20/21 edn. Bergmann, Munich

    Google Scholar 

  14. Hafferl A (1969) Lehrbuch der topographischen Anatomie, 3rd edn. Springer, Berlin

    Google Scholar 

  15. Pernkopf E (1952) Topographische Anatomie des Menschen, vol 3. Urban and Schwarzenberg, Vienna

    Google Scholar 

  16. Töndury G (1981) Angewandte und topographische Anatomie des Menschen, 5th edn. Thieme, Stuttgart

    Google Scholar 

  17. 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

    Google Scholar 

  18. Hauke B (1973) Schlingenbildung der Arteria carotis und Arteria vertebralis. Dtsch Med Wochenschr 98: 2381–2384

    Google Scholar 

  19. 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

    Google Scholar 

  20. Krayenbühl H, Yarsagil MG (1957) Die vaskulären Erkrankungen im Gebiet der Arteria vertebralis und der Arteria basilaris. Thieme, Stuttgart, p 38

    Google Scholar 

  21. Macke A, Macke-Ribert C (1977) L'artère carotide interne. Étude anatomique et microradiographique, Exploration endoluminale. Medical thesis, University of Lille

  22. Wuttke V, Schmitt R, Pogan J, Clar HE (1990) Cervical nerve root compression syndrome caused by the vertebral artery. RÖFO 152: 473–474

    Google Scholar 

  23. Glover JR, Kennedy C, Coral A (1990) Tortuous vertebral artery-onset of symptoms during pregnancy. Clin Radiol 41: 66–68

    Google Scholar 

  24. 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

    Google Scholar 

  25. 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

    Google Scholar 

  26. Beranek L (1984) Erosion of cervical intervertebral foramen by a buckle of the vertebral artery. Rev Rhum Mal Osteoartic 51: 439

    Google Scholar 

  27. Palmer FJ, Sequiera M (1980) Cervical vertebral erosion and vertebral artery tortuosity: an angiographic study. Australas Radiol 24: 20–23

    Google Scholar 

  28. 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

    Google Scholar 

  29. 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

    Google Scholar 

  30. Poindexter JM, Patel K, Clauss RH (1987) Management of kinked extracranial cerebral arteries. J Vasc Surg 6: 127–133

    Google Scholar 

  31. 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

    Google Scholar 

  32. Argenson C, Francke JP (1980) The vertebral arteries (segments V1 and V2). Anat Clin 2: 29–41

    Google Scholar 

  33. Sakamoto H (1980) A case of right vertebral artery as the last branch of the aortic arch. Kaibogaku Zasshi 55: 503–508

    Google Scholar 

  34. Cadaver S, Arisan E (1989) Variations in the extracranial origin of the human vertebral artery. Acta Anat 135: 236–238

    Google Scholar 

  35. 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

    Google Scholar 

  36. Padget DH (1964) Designation of the embryonic intersegmental arteries in reference to the vertebral artery and subclavian stem. Anat Rec 119: 349–356

    Google Scholar 

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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

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  • DOI: https://doi.org/10.1007/BF00602620

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