Surgical and Radiologic Anatomy

, Volume 40, Issue 7, pp 799–806 | Cite as

Prevalence and anatomy of anomalous left vertebral artery originated from aorta evaluated by computed tomographic angiography

  • Yunsuk Choi
  • Sang Bong Chung
  • Myoung Soo Kim
Original Article



We evaluated anatomical characteristics and clinical significance of left vertebral artery (VA) originating from aortic arch (AA) by computed tomography (CT) angiography.


CT angiography was performed in 3460 patients between March 01, 2014 and November 30, 2015. We examined course of prevertebral VA (PVVA) segment and level of entry into the cervical vertebra transverse foramen (CVTF) of left VA originated from AA.


One hundred fifty-three of 3460 patients had left VA originated from AA. Six of 153 patients had dual origin of VA. Entry level to CVTF of 156 left VAs in 153 cases ranged from C3 to C6. Entry level to CVTF of 156 right VAs in 153 cases ranged from C3 to C7. One hundred fifty-six right PVVA segments positioned in longus colli muscle lateral side in 112 VAs, longus colli muscle anterior surface near longus colli muscle lateral margin in 41 VAs, and unknown location in three VAs. One hundred fifty-six left PVVA segments positioned in anterior surface of longus colli muscle midline in 5 cases, anterior surface of longus colli muscle near longus colli lateral margin in 138 cases, longus colli muscle lateral side in 12 cases, and anterior surface of anterior scalene muscle midline in one case.


Left VA may arise from the AA. If a long PVVA segment entering higher CVTF is present, operator can perform anterior cervical surgery via contralateral approach for avoidance of VA injury.


Left vertebral artery Clinical significance Aorta Transverse foramen 



This work was supported by research Grant from a National Medical Center.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest with any organization or institute.


  1. 1.
    Albayram S, Gailloud P, Wasserman BA (2002) Bilateral arch origin of the vertebral arteries. AJNR 23(3):455–458PubMedGoogle Scholar
  2. 2.
    Celikyay ZR, Koner AE, Celikyay F, Deniz C, Acu B, Firat MM (2013) Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data. Clin Imaging 37(6):1011–1019. CrossRefPubMedGoogle Scholar
  3. 3.
    Einstein EH, Song LH, Villela NL, Fasani-Feldberg GB, Jacobs JL, Kim DO, Nathawat A, Patel D, Bender RB, Peters DF (2016) Anomalous origin of the left vertebral artery from the aortic arch. Aorta (Stamford) 4(2):64–67Google Scholar
  4. 4.
    Eskander MS, Connolly PJ, Eskander JP, Brooks DD (2009) Injury of an aberrant vertebral artery during a routine corpectomy: a case report and literature review. Spinal Cord 47(10):773–775. CrossRefPubMedGoogle Scholar
  5. 5.
    Gluncic V, Ivkic G, Marin D, Percac S (1999) Anomalous origin of both vertebral arteries. Clin Anat 12(4):281–284CrossRefPubMedGoogle Scholar
  6. 6.
    Golfinos JG, Dickman CA, Zabramski JM, Sonntag VK, Spetzler RF (1994) Repair of vertebral artery injury during anterior cervical decompression. Spine (Phila Pa 1976) 19(22):2552–2556CrossRefGoogle Scholar
  7. 7.
    Goray VB, Joshi AR, Garg A, Merchant S, Yadav B, Maheshwari P (2005) Aortic arch variation: a unique case with anomalous origin of both vertebral arteries as additional branches of the aortic arch distal to left subclavian artery. AJNR 26(1):93–95PubMedGoogle Scholar
  8. 8.
    Jaffe RB (1991) Radiographic manifestations of congenital anomalies of the aortic arch. Radiol Clin North Am 29(2):319–334PubMedGoogle Scholar
  9. 9.
    Jakanani GC, Adair W (2010) Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol 65(6):481–487. CrossRefPubMedGoogle Scholar
  10. 10.
    Jalali Kondori B, Asadi MH, Rahimian E, Tahsini MR (2016) Anatomical variations in aortic arch branching pattern. Arch Iran Med 19(1):72–74PubMedGoogle Scholar
  11. 11.
    Koenigsberg RA, Pereira L, Nair B, McCormick D, Schwartzman R (2003) Unusual vertebral artery origins: examples and related pathology. Catheter Cardiovasc Interv 59(2):244–250CrossRefPubMedGoogle Scholar
  12. 12.
    Komiyama M, Morikawa T, Nakajima H, Nishikawa M, Yasui T (2001) High incidence of arterial dissection associated with left vertebral artery of aortic origin. Neurol Med Chir (Tokyo) 41(1):8–11 (discussion 11–12) CrossRefGoogle Scholar
  13. 13.
    Lemke AJ, Benndorf G, Liebig T, Felix R (1999) Anomalous origin of the right vertebral artery: review of the literature and case report of right vertebral artery origin distal to the left subclavian artery. AJNR 20(7):1318–1321PubMedGoogle Scholar
  14. 14.
    Lu J, Ebraheim NA (1999) The vertebral artery: surgical anatomy. Orthopedics 22(11):1081–1085PubMedGoogle Scholar
  15. 15.
    Meila D, Tysiac M, Petersen M, Theisen O, Wetter A, Mangold A, Schlunz-Hendann M, Papke K, Brassel F, Berenstein A (2012) Origin and course of the extracranial vertebral artery: CTA findings and embryologic considerations. Clin Neuroradiol 22(4):327–333. CrossRefPubMedGoogle Scholar
  16. 16.
    Müller M, Schmitz BL, Pauls S, Schick M, Rohrer S, Kapapa T, Schlötzer W (2011) Variations of the aortic arch—a study on the most common branching patterns. Acta Radiol 52(7):738–742. CrossRefPubMedGoogle Scholar
  17. 17.
    Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD (2009) Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat 31(5):319–323. CrossRefPubMedGoogle Scholar
  18. 18.
    Satti SR, Cerniglia CA, Koenigsberg RA (2007) Cervical vertebral artery variations: an anatomic study. AJNR Am J Neuroradiol 28(5):976–980PubMedGoogle Scholar
  19. 19.
    Shin IY, Chung YG, Shin WH, Im SB, Hwang SC, Kim BT (2008) A morphometric study on cadaveric aortic arch and its major branches in 25 korean adults: the perspective of endovascular surgery. J Korean Neurosurg Soc 44(2):78–83. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Singla RK, Sharma T, Sachdeva K (2010) “Variant origin of left vertebral artery”. Int J Anat Var 3:97–99Google Scholar
  21. 21.
    Smith MD, Emery SE, Dudley A, Murray KJ, Leventhal M (1993) Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients. J Bone Joint Surg Br 75(3):410–415CrossRefPubMedGoogle Scholar
  22. 22.
    Uchino A, Saito N, Takahashi M, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Nakajima R, Watanabe Y (2013) Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography. Neuroradiology 55(5):585–594. CrossRefPubMedGoogle Scholar
  23. 23.
    Vučurević G, Marinković S, Puškaš L, Kovačević I, Tanasković S, Radak D, Ilić A (2013) Anatomy and radiology of the variations of aortic arch branches in 1,266 patients. Folia Morphol (Warsz) 72(2):113–122CrossRefGoogle Scholar
  24. 24.
    Yamashiro S, Kuniyoshi Y, Arakaki K, Inafuku H, Morishima Y, Kise Y (2010) Total arch replacement with associated anomaly of the left vertebral artery. Ann Thorac Cardiovasc Surg 16(3):216–219PubMedGoogle Scholar
  25. 25.
    Yuan SM (2016) Aberrant origin of vertebral artery and its clinical implications. Braz J Cardiovasc Surg 31(1):52–59. PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryNational Medical CenterSeoulRepublic of Korea

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