ANATOMIC VARIATIONS V.Gluncˇic´ Æ I.K.Lukic´ Æ M. Kopljar M.Sabljar-Matovinovic´ Æ A. Hebrang Æ A.Marusˇic´ Persistent cervical intersegmental artery and aortic arch coarctation Received: 13 April 2001 /Accepted: 20 December 2001 / Published online: 11 July 2002 Ó Springer-Verlag 2002 Abstract A 15-year-old girl presented with upper ex- tremity hypertension and continuous precordial mur- mur. Arteriography revealed aortic coarctation proximal to the origin of the left subclavian artery. An anomalous artery originated from the aortic arch, be- tween the left common carotid artery and the stenosis. It ascended cranially and filled an angiomatous vascular formation on the left side of the neck. The ‘‘angioma’’ drained into the left subclavian artery. The embryolog- ical explanation of the described anomaly is difficult, but probably related to hemodynamic alterations following the prestenotic increase in blood pressure. This may have impaired the obliteration of cervical intersegmental arteries, resulting in the persistence of one of the first three intersegmental arteries as the anomalous branch of the aortic arch. The angiomatous vascular forma- tion in the neck could be the consequence of altered development of anastomoses between the muscular twigs of both vertebral and deep cervical artery. The vessel draining the vascular formation was probably the thyrocervical trunk. Since there were no overt collateral channels or signs of left ventricular hypertrophy by electrocardiography and echocardiography, it seems that the aberrant collateral flow was hemodynamically significant and reduced the afterload on the myocardi- um. Although the pattern of collateral flow in our case might be considered extremely rare, it is important in preoperative planning and interpretation of imaging studies. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at http://dx.doi.org/10.1007/s00276-002-0030-9. Arte`re cervicale intersegmentaire persistante et coarctation de lÕarc aortique Re´sume´ Une jeune fille de 15 ans avait une hypertension de la partie supe´rieure du corps et un souffle pre´cordial continu. L’arte´riographie re´ve´la une coarctation aor- tique en amont de l’origine de l’arte`re subclavie`re gauche. Une arte`re anormale naissait de l’arc de l’aorte, entre l’arte`re carotide commune gauche et la ste´nose. Elle montait et alimentait une formation angiomateuse sur le coˆte´ gauche du cou. L’‘‘angiome’’ se drainait dans l’arte`re subclavie`re gauche. L’explication embryologique de cette anomalie est difficile, probablement lie´e a` des alte´rations he´modynamiques cause´es par l’augmentation de pression sanguine pre´ste´notique. Cela pourrait avoir compromis l’oblite´ration des arte`res cervicales interseg- mentaires, aboutissant a` la persistance de l’une des trois premie`res arte`res intersegmentaires comme branche anormale de l’arc de l’aorte. La formation angiomateuse cervicale pourrait eˆtre la conse´quence du de´veloppement anormal d’anastomoses entre les rameaux musculaires des arte`res verte´brale et cervicale profonde. Le vaisseau drainant la formation vasculaire est probablement le tronc thyro-cervical. Il n’y avait pas de signe manifeste de circulation collate´rale, ni d’hypertrophie ventriculaire Surg Radiol Anat (2002) 24: 226–230 DOI 10.1007/s00276-002-0030-9 The French version of this article is available in the form of elec- tronic supplementary material and can be obtained by using the Springer Link server located at http://dx.doi.org/10.1007/s00276- 002-0030-9. V. Gluncˇic´ Æ I.K. Lukic´ (&) Æ A. Marusˇic´ Department of Anatomy, Zagreb University School of Medicine, S ˇ alata 11, Zagreb, HR-10000, Croatia E-mail: iklukic@mef.hr Tel.: +385-1-4566825 Fax: +385-1-4590195 V. Gluncˇic´ Æ I.K. Lukic´ Æ A. Marusˇic´ Croatian Institute for Brain Research, Zagreb University School of Medicine, S ˇ alata 12, Zagreb, HR-10000, Croatia M. Kopljar Department of Surgery, Sisters of Mercy University Hospital, Vinogradska 29, Zagreb, HR-10000, Croatia M. Sabljar-Matovinovic´ Department of Medicine, Merkur University Hospital, Zajcˇeva 19, Zagreb, HR-10000, Croatia A. Hebrang Department of Radiology, Merkur University Hospital, Zajcˇeva 19, Zagreb, HR-10000, Croatia