大動脈弓—発生と変異

Aortic Arch:Embryology and Remodeling

Point

・各大動脈弓の正常の発生と変異を理解した上で，右側大動脈弓のそれぞれのパターンを理解する．

・右側大動脈弓に合併するaberrant subclavian arteryの特徴を理解する．

　A right aortic arch and aberrant subclavian artery result from an interruption in the remodeling of the pharyngeal arch arteries. We occasionally encounter this anatomical variation during angiography. Patients with disorders such as Down syndrome and congenital heart disease show a high incidence of an aberrant right subclavian artery, and this anomaly can cause symptomatic esophageal or tracheal compression. The root of the aberrant artery may show dilatation（referred to as a Kommerell diverticulum）, dissection, intramural hematoma, or rupture necessitating cardiac intervention using a surgical or endovascular approach. Neurointerventionalists should have working knowledge of the anatomy to rapidly understand the anatomy and ensure a safe procedure. A left transradial approach should be considered if prior knowledge of the aberrant subclavian anatomy is available.