Parathyroid vascular anatomy using intraoperative mapping angiography: the PARATLAS study

Area of Science:

• Vascular anatomy
• Surgical imaging
• Endocrine surgery

Background:

• Understanding parathyroid gland (PG) vascular anatomy is critical for safe thyroidectomy.
• Variations in PG vessel supply can impact surgical outcomes.
• Accurate anatomical knowledge aids in preserving PG function during surgery.

Purpose of the Study:

• To describe the patterns and spatial distribution of parathyroid gland vessels.
• To classify parathyroid vessel anatomy based on their relationship with the thyroid gland.
• To provide surgically relevant insights into parathyroid vascularization.

Main Methods:

• Analysis of intraoperative mapping angiographies using indocyanine green and fluorescence imaging.
• Classification of parathyroid vessels based on their contact patterns with the thyroid gland.
• Data collected from patients undergoing thyroid surgery between February 2020 and September 2021.

Main Results:

• 320 parathyroid glands (PGs) were assessed from 200 angiographies.
• Vessel patterns included no contact (6%), single-point contact (23%), posterior path (15%), lateral path (21%), intrathyroidal path (6%), and medial path (8%).
• Superior PG vessels concentrated around Zuckerkandl's tubercle; inferior PG vessels were anterior and sparse.

Conclusions:

• Intraoperative mapping angiography effectively defines parathyroid vessel patterns relative to the thyroid.
• This technique provides valuable surgical information on spatial vessel distribution.
• Enhanced understanding of PG vascular anatomy can improve surgical safety and outcomes.