An anatomical exploration of the extracranial (V1-V3) and intracranial (V4) components of the vertebral arteries in a select KwaZulu-Natal population.

Abstract

The risk of injury to the vertebral artery is a significant complication of surgery. The presence of anatomical variation in the course of the vertebral artery increases the likelihood of injury. Due to inadequate understanding of the presence and location of anatomical variations in the morphology and morphometry, the vertebral artery can be injured during surgical intervention. Apart from the vascular injury that can occur during surgical intervention, anatomical variations have implications for some pathologies in the posterior circulation territory. These include aneurysm formation, cerebrovascular disorders, posterior circulatory stroke, and some neurovascular problems. In this retrospective observational study, we investigated the anatomical features of the extracranial (V1-V3) and intracranial (V4) components of the vertebral arteries in a South African population. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and White) who had undergone computed tomography angiography (CTA) at Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa, from January 2009 to September 2019. The vertebral artery exhibited various morphological variations in its course. We report the incidence of variant origin of the left vertebral artery (6.9%). The level of entry into the transverse foramen ranged between C7-C3. We report the incidence of vertebral artery tortuosity at V1, V2: 76.6%, and 32.1%, respectively. We observed fenestration at V3 (0.18%) and V4 (0.4%) segments. We registered the incidence of the persistent first intersegmental artery (1.1%), extradural PICA origin (2.8%), atresia (6.7%), and hypoplastic terminal vertebral artery (13.2%). Average length and diameter at each vertebral artery segment were registered; we also report on hypoplasia of the vertebral artery. Anatomical variations of the vertebral artery are common in the South African population studied in the present study. Imaging of the complete segments of the vertebral artery from the origin to the point of convergence to form the basilar artery may be necessary to decide a treatment strategy for interventions in the vicinity of the vertebral artery. Understanding the patterns of anatomical variations of the vertebral arteries will contribute significantly to the diagnosis of various diseases in the posterior circulatory territory. The average diameter was significantly larger on the left in all the racial groups, but there were no significant gender differences. We registered a left dominance pattern in all the segments (V1-V4).

Iqoqa Ingozi yokulimala emithanjeni yomgogodla iyinkinga enzima kakhulu yokuhlinzwa. Ukuba khona kokwehlukahlukana kokwakheka komzimba ekuhambeni komthambo womgogodla kwandisa amathuba okulimala. Ngenxa yokuqonda okunganele kokukhona kanye nendawo yokwehlukahlukana kwesakhikwo somzimba ekwakhekeni nokulinganisa umumo, umthambo womgogodla ungalimala ngesikhathi sokuhlinzwa. Ngaphandle kokulimala kwemithambo yegazi okungenzeka ngesikhathi sokuhlinzwa, ukuhlukahlukana kwemithamdo yomgogodla kunomthelela ngezinye izimbangela ngokuthola umsuka wesifo ngokuhamba kwegazi emigudwini. Lokhu kubandakanya ukwakheka kokuvuvukala komthambo, ukuphazamiseka kokuhamba kwegazi engqondweni, ukushaywa yisifo sohlangothi, nezinye izinkinga ngezinzwa nemithambo. Kulolu cwaningo lokubheka ngokuqhathanisa abanesifo nabangenaso, sibheke ukwakheka komzimba kwamathambo ekhanda ngaphandle (V1-V3) kanye nokwakheka kwawo ngaphakathi (V4) nezingxenye zemithambo yomgogodla emphakathini waseNingizimu Afrikha. Ucwaningo lungukuzibonela ngqo, ukuqhathanisa ngokubuyekeza amashadi eziguli zaseNingizimu Afrikha angama-554 ngokulandelana (abaNsundu, amaNdiya, nabaMhlophe) abafakwe emshinini bahlolwa wonke umzimba ngekhompuyutha ukubona okusemithanjeni (isibonathambomzimba) (CTA) esibhedlela i-Lenmed Ethekwini neSikhungo seNhliziyo, eThekwini, eNingizimu Afrikha, kusukela kuMasingana wowezi-2009 kuya kuMandulo wowezi-2019. Umthambo womgogodla ukhombisa ukwehlukahluka kwesakhiwo ekuthubelezeni kwawo. Sibika isehlakalo semvelaphi esehlukile somthambo womgogodla kwesokunxele (6.9%). Izinga lokungena esikhaleni esiphakathi komthambo womgogodla laliphakathi kwe-C7 ne-C3. Sibika isehlakalo esihambisana nokuguga komthambo womgogodla nomfutho wegazi okulinganiselwa phakathi kuka-V1, V2: 76.6% no-32.1%, ngokulandelana. Sibone ukuhlinzwa kwesakhiwo sendlebe ngaphakathi kwezingxenye ezingu-V3 (0.18%) nezingu-V4 (0.4%). Sabhalisa izehlakalo zomthambo wokuqala ngezingxenye ezilokhu zikhona ngo-1.1%, imvelaphi ye-PICA yamathambo ekhanda (2.8%), isicubu esingenayo embotsheni ngokwemvelo (6.7%), nokungakhuli kwesitho ngokuphelele (13.2%). Isilinganiso sobude nobubanzi engxenyeni ngayinye yomthambo womgogodla yabhaliswa; siphinde sibike ngokungasebenzi ngokwejwayelekile komthambo womgogoda. Ukwehlukahlukana kokwakheka komthambo womgogodla kuvamile kubantu baseNingizimu Afrikha ocwaningweni lwamanje. Ukufanekisa kwezingxenye eziphelele zomthambo womgogodla lapho zihlangana khona ukwenza umthambo ophakathi nendawo ekhanda kungadingakala ukunquma ngamasu okwelapha ngokungenelela endaweni eseduze nomthambo womgogodla. Ukuqonda ukuphiceka kwesakhiwo esahlukahlukene semithambo yomgogodla kuzodlala indima ebalulekile ekuhlonzeni izifo ezahlukahlukene ekuhlinzekweni kokuhamba kwegazi. Isilinganiso sobubanzi besisikhulu kakhulu kwesokunxele kuwo wonke amaqembu ezinhlanga, kodwa kwakungekho mehluko obalulekile phakathi kobulili. Sibhalise indlelakwenza ebihamba phambili kuzo zonke izingxenye ebe ngu-V1-V4.