Email this article The possibilities of ultrasound diagnostics in assessing the structural variants of the bifurcation of the common carotid artery
- Authors: Moshkin A.S.1, Nikolenko V.N.2,3, Khalilov M.A.1, Gavryushova L.V.4, Moshkina L.V.1, Li Z.2,5
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Affiliations:
- Orel State University named after I.S. Turgenev
- Sechenov First Moscow State Medical University
- Lomonosov Moscow State University
- Saratov State Medical University named after V.I. Razumovsky
- Petrovsky National Research Centre of Surgery
- Issue: Vol 10, No 1 (2025)
- Pages: 17-23
- Section: Human Anatomy
- Published: 10.03.2025
- URL: https://innoscience.ru/2500-1388/article/view/643582
- DOI: https://doi.org/10.35693/SIM643582
- ID: 643582
Cite item
Abstract
Aim – to identify various structural variants of the bifurcation of the common carotid artery using the ultrasound imaging method, taking into account the age characteristics of patients.
Material and methods. We examined 1,061 patients (the average age was 57.0±10.7 years). Using ultrasound imaging, the anatomical variant of the bifurcation of the common carotid artery was determined, taking into account the location of the external and internal carotid arteries at the visualization level. The results were grouped according to the age and gender of the patients, statistically processed.
Results. 2,122 vascular complexes were studied (1,396 in women and 726 in men). Five main types of bifurcation structure of the common carotid artery (types A – E) were identified. Type A was the most common among all participants (up to 42%). Type B was detected in up to 35% of men and 27% of women. Type C accounted for 15-19% of cases. Other options were estimated at 4-7%. Taking into account the age, four groups were formed for men and women. At the same time, type A was 41-43% for women, regardless of age, and 31-40% for men. Type B in men in the age group 1 was detected in 48%. Type С was 2-4% more common among women in the age groups 2 and 3. In the older age group of men, type C was 31% and type E was 12% (the most common). In other age groups, D and E types accounted for 4-7%.
Conclusion. The results obtained contribute to the development of personalized directions in the treatment of vascular diseases and help to improve minimally invasive surgical interventions.
Keywords
Full Text
INTRODUCTION
Variable anatomy of the vascular bed demonstrates the importance of systematization of knowledge for subsequent successful implementation of results into clinical practice [1, 2]. The active development of methods of intra-vital diagnostics and modern data processing technologies make it possible to find many new features in the structure of the vascular system [3–5]. The development of minimally invasive surgical interventions and the expansion of personalized approaches in medicine require a more in-depth and detailed assessment of the main vessels [6–8]. The neck area contains the most important main arteries, which are often the site of development of dangerous hemodynamic disorders [9, 10]. Ultrasound diagnostics at the current stage of its development allows not only to evaluate the structure of the vascular wall and hemodynamic parameters, but also to obtain extensive information about the anatomy in the field of visualization [11], and the risk of developing cardiovascular diseases [12–14].
AIM
Using the ultrasound imaging method, taking into account the age characteristics of patients, to identify various structural variants of the bifurcation of the common carotid artery.
MATERIAL AND METHODS
The study was conducted using the SonoAce R7 and Logiq F6 ultrasound diagnostic systems in an outpatient setting. Linear multifrequency sensors were used for visualization. A total of 1061 people (698 women and 363 men) were examined. The age of the study participants ranged from 18 to 88 years, with an average of 57.0±10.7 years.
We determined the anatomical variant of the structure of the bifurcation of the common carotid artery, taking into account the location of the external and internal carotid arteries at the level of visualization. The data were summarized in Microsoft Excel 2007 tables. Statistical data processing was performed in StatSoft Statistica 10 and IBM SPSS Statistics 20 software suites.
RESULTS
By combining data from both sides of the entire visualization, 2122 carotid bifurcations were analyzed. Among women, 1396 vascular structures were assessed, and 726 among men. A visual representation of the normal age distribution among men and women in the work is presented in Figure 1.
Figure 1. Graphs of the normal probability distribution of participants by age, taking into account the gender in the observation (the Shapiro – Wilk W test for women w=0.9674, p=0.0000; for men w=0.9893, p=0.00004).
Рисунок 1. Графики нормального вероятностного распределения участников по возрасту с учетом пола в наблюдении (критерий Шапиро – Уилка для женщин w=0,9674, p=0,0000; для мужчин w=0,9893, p=0,00004).
In our study, we used the original system of determining the structure of the region of carotid bifurcation [3] that comprises 5 types (Fig. 2): А – median position of the external carotid artery; B – ventral position of the internal carotid; C – lateral position of the external carotid artery; D – divergence or intersection of vessels in the bifurcation region; E – medial inclination of carotid arteries.
Figure 2. Structural variants of the bifurcation region of the common carotid artery in the observation.
Рисунок 2. Варианты строения области бифуркации общей сонной артерии в наблюдении.
The general data on normal distribution of participants according to age between men and women is shown in Fig. 3 and Table 1.
Figure 3. Graphs of the normal probability distribution of participants by age, taking into account the type of structure of the bifurcation of the common carotid artery (Shapiro – Wilk W test: type A w=0.9787, p=0.0000; type B w=0.9729, p=0.0000; type C w=0.9701, p=0.0000; type D w=0.9622, p=0.0044; type E w=0.9913, p=0.4966).
Рисунок 3. Графики нормального вероятностного распределения участников по возрасту с учетом типа строения бифуркации общей сонной артерии (критерий Шапиро – Уилка: тип А w=0,9787, p=0,0000; тип Б w=0,9729, p=0,0000; тип В w=0,9701, p=0,0000; тип Г w=0,9622, p=0,0044; тип Д w=0,9913, p=0,4966).
Table 1. Normality tests for age with respect to the type of structure of the bifurcation of the common carotid artery
Таблица 1. Критерии нормальности для возраста с учетом типа строения бифуркации общей сонной артерии
Type of bifurcation structure | Kolmogorov-Smirnov test with Lilliefors significance correction | ||
Statistics | Degree of freedom | Significance | |
1.00 | 0.080 | 867 | 0.000 |
2.00 | 0.090 | 626 | 0.000 |
3.00 | 0.090 | 375 | 0.000 |
4.00 | 0.081 | 105 | 0.089 |
5.00 | 0.054 | 149 | 0.200 |
General data on the occurrence of structural variants of bifurcation of the common carotid artery among participants in absolute and relative values are shown in Table 2.
Type of bifurcation structure | Total number of cases | % among participants | ||||
Women | Men | Total | Women | Men | Total | |
A | 586 | 281 | 867 | 42 | 39 | 40 |
B | 375 | 251 | 626 | 27 | 35 | 30 |
C | 266 | 109 | 375 | 19 | 15 | 18 |
D | 73 | 32 | 105 | 5 | 4 | 5 |
E | 96 | 53 | 149 | 7 | 7 | 7 |
Table 2. Information on the prevalence of various vascular structural variants among all participants in the observation
Таблица 2. Сведения о распространенности различных вариантов строения сосудов среди всех участников наблюдения
The most frequent structural variants of bifurcation are types A and B. Type A comprises up to 40% of all observed cases, reaching 42% in women and 38% in men. Type B comprises up to one third of cases: 35% among men and 27% among women. Type C is found in one fifth of cases: 19% among women and 15% among men. Other variants of the relative position of vessels (D and E), depending on the sex of patients, were found in 4-7%.
In 420 participants of the study (164 men and 256 women) similar structural variants of bifurcation of the common carotid arteries on either side were identified, which comprises 39.6% of the total data in the observation; the general data follows in Table 3.
Table 3. Distribution of the same structural variants of the common carotid artery bifurcation on both sides among the participants in the observation
Таблица 3. Распределение одинаковых вариантов строения бифуркации общей сонной артерии с обеих сторон среди участников наблюдения
Parameter | Type of relative position of vessels | ||||
A | B | C | D | E | |
Number, people | 207 | 126 | 63 | 12 | 12 |
Proportion in the group, % | 49 | 30 | 15 | 3 | 3 |
We then analyzed the results obtained taking into account the gender and age of the patients. The following groups of study participants were formed as per age periods: Group 1, youth and I adult period (men and women aged below 35); Group 2, II adult period (men over 35 and below 60, and women below 55 years of age); Group 3, elderly people (men over 60 years of age and women over 55 and below 74 years of age); Group 4, old people (above 75 years of age).
The distribution of structural variants of main vessels in the region of the common carotid artery bifurcation among participants from various age groups regardless of their sex is shown in Fig. 4 and Tables 4 and 5.
Figure 4. Diagram of the distribution of participants, taking into account the type of structure of the common carotid artery bifurcation and age group (Shapiro – Wilk W test: group 1, w=0.7703, p=0.0000; group 2, w=0.794, p=0.0000; group 3, w=0.8183, p=0.0000; group 4, w=0.8368, p=0.0000).
Рисунок 4. Диаграмма распределения участников с учетом типа строения бифуркации общей сонной артерии и возрастной группы (критерий Шапиро – Уилка: первая группа w=0,7703, p=0,0000; вторая группа w=0,794, p=0,0000; третья группа w=0,8183, p=0,0000; четвертая группа w=0,8368, p=0,0000).
Table 4. Normality test for the type of structure of the bifurcation of the common carotid artery with respect to the age group
Таблица 4. Критерии нормальности для типа строения бифуркации общей сонной артерии с учетом возрастной группы
Type of bifurcation structure | Kolmogorov-Smirnov test with Lilliefors significance correction | Shapiro-Wilk W test | ||||
Statistics | Degree of freedom | Significance | Statistics | Degree of freedom | Significance | |
A | 0.280 | 867 | 0.000 | 0.844 | 867 | 0.000 |
B | 0.263 | 626 | 0.000 | 0.846 | 626 | 0.000 |
C | 0.303 | 375 | 0.000 | 0.834 | 375 | 0.000 |
D | 0.291 | 105 | 0.000 | 0.837 | 105 | 0.000 |
E | 0.264 | 149 | 0.000 | 0.826 | 149 | 0.000 |
Table 5. Normality test for the age group with respect to the type of structure of the bifurcation of the common carotid artery
Таблица 5. Критерии нормальности для возрастной группы с учетом типа строения бифуркации общей сонной артерии
Age group | Kolmogorov-Smirnov test with Lilliefors significance correction | Shapiro-Wilk W test | ||||
Statistics | Degree of freedom | Statistics | Degree of freedom | Statistics | Degree of freedom | |
1 | 0.273 | 178 | 0.000 | 0.770 | 178 | 0.000 |
2 | 0.253 | 770 | 0.000 | 0.794 | 770 | 0.000 |
3 | 0.232 | 1010 | 0.000 | 0.818 | 1010 | 0.000 |
4 | 0.234 | 164 | 0.000 | 0.837 | 164 | 0.000 |
The data on the number of identified types of relative position of vessels in the region of the common carotid artery bifurcation among women and men are shown in Table 6.
Table 6. Distribution of structural variants of the bifurcation of the common carotid artery, taking into account gender and age group
Таблица 6. Распределение вариантов строения бифуркации общей сонной артерии с учетом пола и возрастной группы
Type of relative position of vessels | Women | Men | ||||||
G 1 n=100 | G 2 n=372 | G 3 n=802 | G 4 n=122 | G 5 n=78 | G 6 n=398 | G 7 n=208 | G 8 n=42 | |
A | 44 (44%) | 159 (43%) | 279 (41%) | 51 (43%) | 28 (36%) | 157 (39%) | 83 (40%) | 13 (31%) |
B | 39 (39%) | 106 (28%) | 172 (26%) | 22 (18%) | 37 (48%) | 140 (35%) | 64 (31%) | 10 (24%) |
C | 12 (12%) | 60 (16%) | 137 (20%) | 31 (25%) | 7 (9%) | 50 (13%) | 39 (18%) | 13 (31%) |
D | - | 19 (5%) | 32 (6%) | 10 (8%) | 5 (6%) | 16 (4%) | 10 (5%) | 1 (2%) |
E | 5 (5%) | 28 (8%) | 42 (7%) | 7 (6%) | 1 (1%) | 35 (9%) | 12 (6%) | 5 (12%) |
Most frequently, Type A was found among women, comprising 41-43% of the cases in all age groups. Among men, this type of relative position of vessels was found least frequently, in 31% of the cases, in Group 4.
In the male group, Type B was identified more frequently than in the female group. The largest number of cases was found in Group 1 of men (48%), and the least number in Group 4 (24%). Among women, this variant of relative position of vessels in the region of the common carotid artery bifurcation was 39% of the cases in Group 1, whereas the least number of cases, 18%, was found in age Group 4.
Type C in Groups 1, 2 and 3 was mound 2-4% more frequently in women. In Group 4 among men, Type C was found most frequently comprising 31%.
The remaining types of relative position of vessels (D and E) made up to 4–7% of the cases across the age groups. The greatest value for Type E was found in the among men reaching 12% in Group 4. Type D was not found in women in age Group 1.
DISCUSSION
The study of the variable anatomy of the main arteries of the neck is performed by different teams of specialists. Morphological studies based on pathological examinations are of special interest. P.A. Samptesov et al. (2012) report the data of morphological examination of the main arteries considering individual specifics of the shape of the neck based on examination of bodies of 97 men [15]. F. Hojaij et al. (2019) uses the data of 50 pathological examination to study anatomic peculiarities in the relative position of the carotid arteries, jugular vein and the vagal nerve [16]. The undisputed advantage of pathological examination is its unbiased nature, the possibility of detailed documentation of the study process, and the possibility of append the results of studies with histological specimens. Unfortunately, autopsy data do not always allow for a full assessment of the functional relationships that are most relevant in clinical practice.
Great attention is paid to descriptions of dimensional characteristics of the main arteries of the neck [1]. Many clinical studies dwell, in much detail, on questions of diagnosing [2] or specifics of surgical treatment [4, 6]. The variable anatomy of the main arteries is of particular importance when planning high-tech and minimally invasive surgical interventions [17–19].
The classification of relative position of vessels, presented by us, was originally developed to assess the variability of the main arteries when studying images obtained by magnetic resonance tomography [3], however, in the process of practical work it proved well in performing ultrasonic visualization.
In vascular surgery, the area of intravascular interventions is rapidly developing [9], allowing for the individual characteristics of the anatomy of the main arteries to be taken into account directly at the operating table. Methods of minimally invasive surgery require refined knowledge of individual variability of the bloodstream. The region of the bifurcation of the common carotid artery includes one of the most important reflexogenic zones of vegetative innervation, and is the location of the most frequent diagnostic of significant atherosclerotic changes at the level of the vessel wall. Contemporary methods of processing of diagnostic information using computers enable the use of methods of computer analysis, create realistic three-dimensional models facilitating surgery planning [20, 21].
The data on age and sex factors associated with varying anatomy of the main arteries in the region of bifurcation presented in this paper, combined with ultrasonic visualization, enable improvement of personalized approach in medicine [11].
Our study demonstrates the possibility of practical implementation if a simple, straightforward and effective method to determine anatomic variants of the structure of the common carotid artery bifurcation. The relatively large scope of research allowed for a precise identification of the rare types (D and E) and formation of participant groups with respect to their age.
CONCLUSION
Our study presents the possibilities of ultrasonic visualization of the anatomical variations in the structure of the common carotid artery bifurcation. The considerable size of our sampling allowed showing the correlations of prevalence of the different anatomic variants among men and women, and taking into account the factor of the patients’ age.
In general, typical variants of relative position of the vessels (types A and B) are most frequent with Type A being prevalent among women. Type B variant of the vessel relative position is seen more often in young men. Type C, in its turn, is more often identified in both men and women, as the age progresses. Rare types of vessel position (D and E) are identified in 4-7% of the cases; and only in men of II adult period type E comprised 12% cases.
The presented data are relevant for assessing the variable anatomy of the main arteries of the neck, allowing development of personalized directions in the treatment of vascular diseases and improvement of minimally invasive surgical interventions.
ADDITIONAL INFORMATION | ДОПОЛНИТЕЛЬНАЯ ИНФОРМАЦИЯ |
Study funding. The work was carried out at Orеl State University named after I.S. Turgenev within the framework of the state assignment No. 075-00196-24-08 for 2024 and for the planning period of 2025 and 2026 dated August 23, 2024, project No. FSGN-2024-0014 (1024041900023-6-1.2.1; 2.6.2; 3.1.3; 3.2.12; 3.2.4). | Источник финансирования. Работа выполнена в ФГБОУ ВО «Орловский государственный университет имени И.С. Тургенева» в рамках государственного задания № 075-00196-24-08 на 2024 год и на плановый период 2025 и 2026 годов от 23.08.2024 г., проект № FSGN-2024-0014 (1024041900023-6-1.2.1;2.6.2;3.1.3;3.2.12;3.2.4). |
Conflict of interest. The authors declare that there are no obvious or potential conflicts of interest associated with the content of this article. | Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи. |
Compliance with Ethical Standards The authors confirm that the rights of the people who participated in the study were respected, including obtaining informed consent where necessary. The study protocol was approved by the local Ethics Committee of the Orеl State University named after I.S. Turgenev (protocol No. 25 dated November 16, 2022). | Соответствие нормам этики Авторы подтверждают, что соблюдены права людей, принимавших участие в исследовании, включая получение информированного согласия в тех случаях, когда оно необходимо. Протокол исследования был одобрен локальным этическим комитетом ФГБОУ ВО «Орловский государственный университет имени И.С. Тургенева» Министерства науки и высшего образования РФ (протокол № 25 от 16 ноября 2022 г.). |
Contribution of individual authors. A.S. Moshkin – organization of the theoretical and clinical part of the research, conducting the research, editing of the manuscript. V.N. Nikolenko – design of the research; interpretation of the research results. M.A. Khalilov – statistical data processing; editing of the manuscript. L.V. Gavryushova – coordination of the clinical part of the research, interpretation of the research results. L.V. Moshkina – statistical processing, editing the manuscript. Zhi Li – statistical data processing; interpretation of research results. All authors gave their final approval of the manuscript for submission, and agreed to be accountable for all aspects of the work, implying proper study and resolution of issues related to the accuracy or integrity of any part of the work. | Участие авторов. А.С. Мошкин – организация теоретической и клинической части исследований, проведение исследования, редактирование рукописи. В.Н. Николенко – оформление дизайна исследования; интерпретация результатов исследования. М.А. Халилов – статистическая обработка данных; редактирование рукописи. Л.В. Гаврюшова – координация клинической части исследования, интерпретация результатов исследования. Л.В. Мошкина – статистическая обработка, редактирование рукописи. Чжи Ли – статистическая обработка данных; интерпретация результатов исследования. Все авторы одобрили финальную версию статьи перед публикацией, выразили согласие нести ответственность за все аспекты работы, подразумевающую надлежащее изучение и решение вопросов, связанных с точностью или добросовестностью любой части работы. |
About the authors
Andrei S. Moshkin
Orel State University named after I.S. Turgenev
Author for correspondence.
Email: as.moshkin@internet.ru
ORCID iD: 0000-0003-2085-0718
MD, Cand. Sci. (Medicine), Associate Professor of the Department of Anatomy, Operative Surgery and Disaster Medicine
Russian Federation, OrelVladimir N. Nikolenko
Sechenov First Moscow State Medical University; Lomonosov Moscow State University
Email: vn.nikolenko@yandex.ru
ORCID iD: 0000-0001-9532-9957
MD, Dr. Sci. (Medicine), Professor, Head of the Department of Human Anatomy and Histology, Head of the Department of the Normal and Topographic Anatomy
Russian Federation, Moscow; MoscowMaksud A. Khalilov
Orel State University named after I.S. Turgenev
Email: halilov.66@mail.ru
ORCID iD: 0000-0003-3529-0557
MD, Dr. Sci. (Medicine), Professor, Head of the Department of Anatomy, Operative Surgery and Disaster Medicine
Russian Federation, OrelLiliya V. Gavryushova
Saratov State Medical University named after V.I. Razumovsky
Email: gavryushova.liliya@yandex.ru
ORCID iD: 0000-0003-4810-0695
MD, Cand. Sci. (Medicine), Associate Professor of the Department of Therapeutic Dentistry
Russian Federation, SaratovLyubov V. Moshkina
Orel State University named after I.S. Turgenev
Email: moshkina.l@internet.ru
ORCID iD: 0009-0008-1328-1880
MD, assistant at the Department of Anatomy, Operative Surgery and Disaster Medicine
Russian Federation, OrelZhi Li
Sechenov First Moscow State Medical University; Petrovsky National Research Centre of Surgery
Email: li-zhi@mail.ru
ORCID iD: 0000-0003-2062-8463
MD, Postgraduate of Vascular Surgery Department
Russian Federation, Moscow; MoscowReferences
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Supplementary files
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).