Retrospective Computed Tomography Angiogram Investigation on the Subclavian Artery Branching Pattern and Origin
Bibliographic record
Abstract
Intro The subclavian artery (SCA) is a substantial vessel with several branches and therefore potential branching patterns. Knowledge of the subclavian artery and its associated branches is important in vascular surgeries of the upper extremity and aorta in order to avoid bleeding and injury. Typical branching order off the SCA is Vertebral (VA), Internal Thoracic (ITA), Thyrocervical (TCT), Costocervical (CCT) and Dorsal Scapular Artery (DSA), however, significant variations to this traditional understanding may exist. The purpose of this study is to characterize the variations in the origin and branching pattern of SCA branches using measurements from patient Computed Tomography Angiograms (CTAs). Methods Head & neck and upper limb CTAs from 55 patients (bilaterally, 110 scans) were retrospectively reviewed on 3D visualizing software TeraRecon. Of these, 101 CTAs displaying left (n=49) and right (n=52) SCAs of sufficient resolution and clarity were selected. Measurements were taken of the distance at which SCA branches originated from the aorta using the software's distance measuring tool and manually tracing the path of SCA to each branch origin. Also, the number of branches and their respective order were counted. Results Five branches originated directly from the SCA with the highest frequency: VA (97.0%), ITA (91.1%), TCT (90.1%), CCT (77.2%), and DSA (57.4%). Only 13 SCAs (12.9%) were observed to have exhibited the typical pattern. VA originated first in 80.2% of SCAs, with ITA arising second (41.3%), TCT as third (47.3%), CCT as fourth (43.6%) and DSA as the fifth branch (56.9%). Common aberrant branches that arose directly from the SCA were Ascending Cervical (4.9%), Deep Cervical (9.9%), Inferior Thyroid (7.9%) and Supreme Intercostal Artery (8.9%). Discussion The subclavian artery branching order and pattern may present significant variation from the typical order. Our findings demonstrate that, within our sample, ITA and TCT arise 2nd (41.1%) and 3rd (46.9%), respectively. These arteries may frequently swap in order for ITA to originate 3rd (32.6%), and TCT to originate 2nd (31.9%). However, VA reliably originates as the most proximal branch (80.2%). The variability in subclavian artery branching pattern poses a challenge in subclavian artery surgery such as SCA‐Common Carotid Artery bypass and transposition. The findings of this study will be used to define the optimal patient position for safe and maximal exposure of the SCA in the supraclavicular surgical window.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".