The Subclavian artery is a major branch of the Aorta. In the left the subclavian artery arises from aortic arch, and in the right it arises from the Brachiocephalic trunk This artery passes from the subclavian groove on the first rib and continues as Axillary artery. The Subclavian artery has several branches that supply chest wall, Thyroid gland and cervical region. Several variations about the Subclavian artery and its branches were have been reported. In this case, from the first part of this artery, we found a common trunk that gives the Ascending cervical, Transvers cervical, Suprascapular and Dorsal scapular arteries. The inferior thyroid artery was absent.

Objective: This study assessed the relation of recurrent coarctation and repair in infancy and complications after subclavian flap aortoplasty. Materials and Methods: In this retrospective study, 31 patients who underwent subclavian flap aortoplasty between 1994 and 2004 were evaluated. The median age was 1.3±1 years, 61.3% of patients were males and 38.7 were females. The frequency of associated heart malformation was: PDA (77.4%), VSD (29%), AS (19.4%), and MS (9.7%). Results: The average follow up period was 34 months (1-126 months). The pre-operative median peak gradient was 64±21.5 mm Hg and the post-operative median peak gradient was 15.4±12.8. Recurrent coarctation was seen in one patient (3.2%) in angiography who was treated with balloon angioplasty. Acute arm ischemia or gangrene and left arm malfunction was not seen. There were no paraplegia, bleeding, or chylothorax. The early mortality was 3.2% (1 patient) due to heart failure. Conclusion: We believe surgical repair for coarctation in neonatal & infantile gives no rise to incidence of re-coarctation and also decreases postoperative complications such as hypertension. Therefore, it should be done as soon as possible. SCFA remains an effective technique for repair of aortic coarctation with excellent results and low morbidity and mortality.      

A retrospective study of 31 patients who underwent subclavian flap aortoplasty between 1994 and 2004 was carried out.The patients included 31 children with a median age of 1.3 years, 61.3% of patients were male and 3 8.7% were female.The frequency of associated heart malformation was: PDA (77.4%), VSD (29%), AS (19.4%), MS (9.7%). The patients were followed 1-126 months with median 34 months.Recoarctation occurred in 1 patient (3.2%) who was treated with Balloon angioplasty.No case had acute ischemia or gangrene or left hand malfunction was not seen. There were no paraplegia and bleeding and chilothoracs. The early mortality was 3.2% (1 patient).In conclusion we believe that the surgical repair of pediatric coarctation as soon as possible not only do not increase incidence of recoarctation but also decreases postoperative complications such as hypertension.SCFA remains an effective technique for repair of aortic coarctation with excellent results and low morbidity and mortality.

Background: The branches of right and left subclavian arteries are important in conducting of blood to spinal cord, posterior cranial fossa, base of the neck, thyroid gland, wall of the thorax and abdomen. The routine use of internal thoracic artery as a conduit in coronary artery bypass grafting surgery requires appreciation of the anatomical variations of these vessels. So far, there is not any report about the variation of subclavian artery and it’s branches in Iran, for this reason this study have been done to see the variations of the subclavian arteries and its branches.Materials and methods: The base of the neck of 40 male cadavers approximately 40- 80 years old were dissected bilaterally with appropriate equipments. The specimens were fixed with routine fixative in dissection hall.Findings: In all specimens the left subclavian artery had normal origin but the right subclavian artery in one case originated from the beginning of the arch of aorta and in another one a retroesophageal right subclavian artery was present. We have seen that, the left vertebral artery in 2 cadavers and right vertebral artery in 1 specimen, rose from arch of aorta. This study showed that the variation of thyrocervical and internal thoracic arteries are uncommon. Conclusion: For preserving the integrity of important structures in the base of the neck, especially thyroid gland in surgery, this vascular variations are presented to physicians to keep in mind that such variations exists during diagnostic investigation and surgical procedures of the neck. An awareness of these variations is important, because this area in used for diagnostic and surgical procedures.

The vertebral artery (VA) originates from the first part of the subclavian artery. The incidence of the aberrant origin of the left VA directly from the aortic arch has been investigated in some societies and has been estimated to be from 1 to 5 percent. Aortic origin of the right vertebral artery is a rare variant. The incidence of this anomaly has not been reported in Iran. During a routine dissection of a white 30-year-old man, the VA originating from the left subclavian artery was not observed, but the aortic arch had an additional artery that had entered into the foramen transversarium of the 6th cervical vertebra. In assessment of the posterior cranial fossa both left and right VA were observed. Other subclavian branches and the origin of the right vertebral artery were normal. The lack of the left VA originating from the subclavian and the presence of an aortic arch originated artery with a similar path to VA, suggests the aberrant origin of the left VA from the aortic arch. The knowledge of these potential variations in the vertebral artery origin could prevent surgical complications or wrong diagnosis in supraaortic vascular surgery and diagnostic procedures like angiography.

Variations of the vertebral artery origin are congenital abnormalities that occur during embryonic development. The vertebral artery origins from the superior part of the first part of the subclavian artery and it provides the main blood supply of the posterior cranial fossa structures. Several variations in the vertebral artery origin and its entry to the transverse foramen have been reported in advance. However, mention to the variation of the right vertebral artery origin and its entrance to the transverse foramen is rare. By describing dissection of an old man cadaver, two vertebral arteries were observed which were arised from the first part of the subclavian artery at the right side, and they follow a different direction to enter the transverse foramen. One of the arteries rises in its natural direction and enters into the transverse foramen of C6, and the other arteries take an abnormal direction upwards and then enter the higher level surface into the transverse foramen of C4. It is necessary to mention, the artery on the left was in its normal state. Regarding neck root surgery, knowing these variations reduces arterial injury during surgery and angiography.

Blunt traumatic aortic transection (TAT) is an uncommon injury with high morbidity and mortality. There has been controversy about the diagnostic methods, approach to the injury, repair time, and surgical techniques. Active augmentation of distal perfusion pressure during cross clamp is still considered as the best surgical treatment. Today, helical CT scan has replaced angiography as the best diagnostic method. There is an incidence of life-threatening arrhythmia such as ventricular fibrillation (VF) during TAT repair, especially in critically unstable patients. One of the catastrophic events, especially occurring in hemodynamically unstable patients (due to multiple trauma and/or myocardial contusion) or severely anemic patients (due to hemorrhage from different body sites) or hypoxic patients (due to myocardial and/or lung contusion) are dangerous cardiac arrhythmias, especially VF due to the manipulation of TAT site or unexpected hemorrhage from the TAT site. Meanwhile, if aorta is clamped on both sides of the TAT site despite the patient being on full cardiopulmonary bypass (CPB) through femoral cannulation, VF carries the risk of low perfusion in the ascending aorta and the arch of aorta and subsequent brain hypoxia and damage. Prophylactic cannulation of the right subclavian artery at the beginning of the surgery, in addition to femoral cannulation before left thoracotomy, can be life-saving for the patients. Presented in this report is a 21-year-old man with multiple trauma and severe head injury due to a motorcycle accident who developed TAT. First, the patient underwent cannulation of femoral artery and vein, as well as cannulation of the right subclavian artery. After opening the left pleural cavity with posterolateral thoracotomy incision, full CPB was started through femoral cannulation. The patient suddenly developed VF during manipulation of the TAT site. The right subclavian artery cannula was immediately opened resulting in complete perfusion of ascending aorta and arch of aorta preventing brain hypoxia.Conclusions: Prophylactic right subclavian artery cannulation in TAT repair, especially in hemodynamically unstable or hypoxic patients, or those with severe anemia can create a safe margin for the surgeon to prevent brain damage during this high-risk-operation.

Background & Aim: Coarctation accounts for about 5-9% of congenital heart diseases and is the fifth common congenital heart disorder in children. Approximately 90% of untreated patients die before the age of 50 and about half of deaths occur before the age of 10 due to heart failure. The main goal of this study is assessing the frequency of reccurent coarctation after repair and determining the results and complications after subclavian flap aortoplasty. Patients & Method: In this retrospective study, the results of surgical repairs for coarctation of aorta in 188 patients under 14 who had been treated at the Rajaee Heart Center were evaluated. Results: The average age of patients was 5.5 years. 72.3% of cases were male and 27.7% were female, including 61 pure coarctation patients. The frequency of associated heart malformations was PDA(Patent Ductus Arteriosus)(67.6%), VSD(Ventricular Septal Defect)(21.8%), AS(Aortic Stenosis)(20%), Bicuspid Aortic Valve(15.4%), MS(Mitral Stenosis)(6.4%), Shone Complex(4.8%), and ASD(Atrial Septal Defect)(3.2%). The proportion of stenosis was 78% for discrete and 22% for long segment. The most common methods of surgical treatment included patch-graft aortoplasty(59%), resection with end-to-end anastomosis(20.7%), and SCFA(16.5%). None of them experienced paraplegia. The patients were followed for 1-126 months with a mean of 41.6 months. In postoperative echocardiography, 29% of cases showed PG(Peak Gradian)≥25mmHg of whom 10% had undoubted recoarctation according to angiography. Later, these patients underwent Balloon Angioplasty. The highest incidence rate of recoarctation was found in patch-graft aortoplasty method(12.7%) and the lowest in SCFA(3.2%). The rate was 10.3% in end-to-end anastomosis. No case experienced acute ischemia, gangrene or left hand dysfunction in SCFA method during follow-up. The incidence of recoarctation in long segment stenosis was significantly more than discrete one(30% versus 4%, P=0.001). In patients younger than 1 year, the incidence of recoarctation was lower than those older than 1 year and those above 5 years(4% versus 15% and 10%). Conclusion: In conclusion, we believe that surgical repair for neonatal and infantile coarctation gives no rise to incidence of recoarctation and decreases postoperation complications such as HTN(Hypertension). Therefore, it should be done as soon as possible. Regarding fewer complications in SCFA method, it provides an excellent method of surgical repair especially in young age

Background: Aortic coarctation is a common disease which has serious consequences such as death. The definite treatment is surgery, and recognizing the complications of this surgery will reduce the consequences. Therefore, we decided to study the outcomes of this surgery over four years.Methods: The study includes 132 patients who underwent reconstructive surgery in Shahid Chamran Hospital, Isfahan, Iran, during 2011-2015. The needed information including the type of the surgery and the complications was collected through the patients’ records and calling them. Chi-square, Student's t, and ANOVA tests were used to compare the data.Findings: Relapse was observed in 17 patients (12.9%), hemorrhage in 3 patients (2.3%), chylothorax in 2 patients (1.5%), endocarditis in one patient (0.8%), blood pressure contradictory in 20 patients (15.2%), and death in 4 patients (3.0%). Only relapse rate was higher in patients older than 20 years, as compared to patients younger than 20 years (20.0% vs.4.8%, P=0.009). As well as, relapse rate was higher in patients under artificial patch (19.2%) as compared to the other groups and lowest relapse rate was observed in patients under the subclavian artery flap (0.0%) (P=0.028); but on the other side, no significant correlation was not found between other complications with age, sex, and type of surgical repair.Conclusion: According to the result of this study, complications in patients undergoing reconstructive surgery were high and also that was higher in older age patients. We also discovered that the complications were the least when using subclavian artery flap method in the reconstructive surgery.

The Axillary artery, a continuation of the subclavian artery, begins at the first rib's outer border, ending normally at the inferior border of the Teres major muscle and continuing further distally as Brachial artery.The Axillary artery has several branches that supplies axillary region. Several variations about the axillary artery and it's branches have been reported. In this case, from the second part of axillary artery, we found a common trunk between Lateral thoracic and Subscapular arteries. Other branches of subscapular also has been separated from this trunk.