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Subclavian Artery Branch Variability based on Computed Tomography Angiography
Oonagh Scallan, MS, Juwan Ryu, Luc Dubois, MD, Deljit Dhanoa, Guy DeRose, MD, Adam Power, MD.
Western University, London, ON, Canada.
OBJECTIVE: Despite the increasing frequency of upper extremity vascular imaging, there is little existing literature on the characteristics of the branching pattern of the subclavian artery (SCA). The objective of this study was to enhance current knowledge of the SCA by using computed tomography angiography (CTA) to analyze its branching patterns.
METHODS: All upper limb CTAs and select head and neck CTAs performed at our institution from January 2008 to January 2015 were reviewed retrospectively. Overall, 74 CTAs were reviewed from this period. Of those, 55 CTAs showing 101 SCA in 55 patients were of sufficient resolution to determine arterial anatomy. Data was collected using the software program Intuition (TeraRecon) and included number of vessels branching from the SCA, position of the branch on the subclavian, distance from the aorta to each vessel branch, and the diameter of the vessels at their origin from the SCA.
RESULTS: Only 13 subclavian arteries (12.9%) were found to have the typical five branches in the order of vertebral artery (VA), internal thoracic artery (ITA), thyrocervical trunk (TCT), costocervical trunk (CCT) and dorsal scapular artery (DSA). The remaining vessels were variable in number of branches, which arteries originated from the subclavian and the order of branching arteries. The number of branches ranged between three and seven. VA branched directly from the SCA in 98 cases (97.0%), ITA in 92 (91.1%), TCT in 89 (88.1%), CCT in 79 (78.2%) and DSA in 59 (58.4%). The most frequently identified aberrant vessels originating from SCA were deep cervical (9.9%), superior intercostal (8.9%), inferior thyroid (7.9%) and a common trunk between ITA and TCT (6.9%). Other atypical branches included ascending cervical (4.9%), suprascapular (1.0%), an accessory vertebral artery (1.0%) or common trunks between vessels. On average, the VA originated half way along the SCA when measured from the aorta, but varied from 3.1cm to 81.6cm (3.2% to 70.3% of the length).
CONCLUSION: Branching of the subclavian artery is far more variable than traditionally thought. Knowledge of the specific branching patterns is critical when treating upper extremity vascular disease.
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