Rare variant of aortic arch branching - a case report.

During the dissection of an 82-year-old male, we found an atypical variant of the aortic arch with five branches instead of the usual three. The additional arteries were identified as the ima thyroid artery (the artery of Neubauer) and the left vertebral artery, which arose directly from the aortic arch. The ima artery was located between the origin of the brachiocephalic trunk and the left common carotid artery. The left vertebral artery was situated between the origin of the left common carotid artery and the left subclavian artery. No other variations in the origins of major vessels in the thoracic region, head and neck were observed. The frequency of the left vertebral artery arising directly from the aortic arch is estimated to be 3-8%, and when combined with the ima artery arising directly from the aortic arch, which occurs in less than 1% of cases, the variant described appears to be extremely rare. In this paper, we present the exact measurements of the arteries we found, their topography relative to other significant anatomical structures, and the potential clinical significance of these variations.