Related Experiment Video
Updated: May 3, 2026

Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Vertebral artery variations in thoracic aortic patients
Kazuhiro Ohkura1, Norihiko Shiiya2, Naoki Washiyama2
1The First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Japan ohkurasato@yahoo.co.jp.
Preoperative magnetic resonance angiography (MRA) identifies vertebral artery variations, crucial for preventing brain infarction during thoracic aortic surgery. Careful management of left vertebral artery origins and variations ensures patient safety.
Area of Science:
- Vascular Surgery
- Neuroradiology
- Cardiovascular Imaging
Background:
- Vertebral artery variations are common and can lead to brain infarction, particularly with left subclavian artery occlusion and posterior inferior cerebellar artery (PICA) termination.
- Preoperative assessment of vertebral artery anatomy is vital for surgical planning in thoracic aortic procedures.
Purpose of the Study:
- To evaluate the impact of preoperative magnetic resonance angiography (MRA) on operative strategies for thoracic aortic surgery.
- To determine the prevalence of vertebral artery variations and occlusive lesions.
Main Methods:
- Retrospective analysis of 159 patients who underwent thoracic aortic surgery with preoperative MRA.
- Assessment of vertebral artery variations (hypoplasia, PICA termination, arch origin) and occlusive lesions.
- Review of surgical strategies and patient outcomes.
Main Results:
- Prevalence of right vertebral artery variations included 12% hypoplasia, 6% PICA termination, and 8% occlusive lesions.
- Left vertebral artery variations included 6% hypoplasia, 3% PICA termination, 4% arch origin, and 2% occlusive lesions.
- No brain infarction occurred with tailored surgical strategies, including debranching bypass and reconstruction.
Conclusions:
- Approximately 30% of patients present with variations (PICA termination, right-sided hypoplasia/occlusion) requiring attention for brain protection.
- Left vertebral arteries originating from the aortic arch necessitate careful management due to a high prevalence of PICA termination.
More Related Videos
Related Concept Videos
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic Aorta
The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...
Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
Abdominal Aorta
The celiac trunk, a singular artery, divides into the left gastric artery, which...
Veins of Thorax
The azygos vein, positioned just right of the midline and anterior to the vertebral column, begins at the junction of the right ascending lumbar and subcostal veins, terminating in the superior vena cava. This vein drains blood from the right side of the thoracic wall, thoracic viscera, and posterior abdominal wall.
The...

