Anatomical Variations of Aortic Arch and Vertebral Arteries

Anatomical variations of the aortic arch and vertebral arteries arise from deviations in embryological vessel development and have important implications for cardiovascular surgery, endovascular interventions and diagnostic imaging. The aortic arch may present with altered branching patterns—such as common origins of the carotid arteries, bovine arch configurations or direct vertebral artery branches—that occur in up to one third of individuals. Vertebral arteries may also vary in their site of origin, course, entry level into cervical transverse foramina, calibre and dominance. Such variations influence cerebral perfusion, risk of vascular injury during cervical spine or neck procedures and the planning of stent or graft placements. Advances in non-invasive imaging, particularly computed tomography angiography, have enabled large-scale population studies that quantify the prevalence of specific variants and characterise their demographic and clinical associations. A comprehensive understanding of these patterns supports safer surgical approaches, more accurate interpretation of imaging studies and improved outcomes in neurosurgical and vascular interventions worldwide.

Research from Nature Portfolio

A large retrospective computed tomography angiography study of over 200 subjects examined both the origin of vertebral arteries and their entrance level into cervical transverse foramina. Normal entry at C6 occurred in over 90 % of courses, while abnormal entry between C3 and C7 appeared in 8.3 % of vessels. Abnormal origin directly from the aortic arch was observed in 1.6 % of cases, all on the left side. Importantly, subjects with an aberrant origin displayed a fivefold increase in entry-level variation. These findings highlight the interdependence of vertebral artery origin and cervical course, emphasising the need for detailed preoperative vascular mapping in interventions involving the neck and upper thorax.

Anatomical Variations of Aortic Arch and Vertebral Arteries publication trend

The graph below shows the total number of articles in anatomical variations of aortic arch and vertebral arteries across all publications each year (not limited to Nature Index journals).

Technical terms

Aortic arch: The curved portion of the aorta between ascending and descending segments from which main head and neck vessels arise.

Vertebral artery: One of two arteries supplying the posterior cerebral circulation, normally arising from the subclavian artery and ascending through cervical transverse foramina.

Transverse foramen: Paired openings in cervical vertebrae through which the vertebral artery ascends.

Bovine arch: A common variant in which the left common carotid artery shares a common origin with the brachiocephalic trunk.

Hypoplasia: Underdevelopment or reduced calibre of a vessel compared with normal dimensions.

Tortuosity: Curving or twisting of a vessel along its course, often increasing procedural complexity.

Aberrant origin: A vessel originating from an atypical parent artery, for example a vertebral artery arising directly from the aortic arch.

References

1. Entrance and origin of the extracranial vertebral artery found on computed tomography angiography. Scientific Reports (2022).
2. The Vertebral Artery: A Systematic Review and a Meta-Analysis of the Current Literature. Diagnostics (2023).
3. An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population. Surgical and Radiologic Anatomy (2021).
4. Anatomical variation in the branching pattern of the aortic arch: a literature review. Irish Journal of Medical Science (2022).