Wacker F, Lippert H, Pabst R. Arterial Variations in Humans: Key Reference for Radiologists and Surgeons: Classification and Frequency. Thieme; 2017; 220 pp; 933 ill; $159.99

Patients are unique. Nowhere is this better illustrated than in the wide variety of arterial anatomic variations. Here, variation should paradoxically be considered the rule rather than the exception; over half of all patients exhibit some arterial variation in the Circle of Willis,¹ 40% show variation in the internal iliac arteries,² and more than 35% exhibit some anatomic variation in the celiac axis.³ Therefore, knowing only the “normal” arterial anatomy is insufficient for diagnostic radiologists, interventional radiologists, and surgeons alike.

This book is based on a text first published by H. Lippert and R. Pabst in 1985 called Arterial Variations in Man: Classification and Frequency. It expands on this book with updated schematic drawings and CTA, MRA, and DSA images. This 206-page book is well illustrated, containing over 900 images. It is broken down into 5 parts: Part 1 – Heart and Thorax, Part 2 – Pelvis and Abdomen, Part 3 – Lower Limbs, Part 4 – Upper Limbs, and Part 5 – Head and Spinal Cord. Each part contains between 7 and 17 chapters dedicated to a certain blood vessel or vascular territory.

The neuro section, entitled “Head and Spinal Cord,” has the following chapters: Subclavian Artery, Inferior Thyroid Artery, Vertebral Artery, External Carotid Artery, Maxillary Artery, Development of the Arteries of the Head, Ophthalmic Artery, Cerebral Arterial Circle (Circle of Willis), and finally, Arteries of the Spinal Cord. It is 37 pages long.

Each section is fairly comprehensive. Textbook or “normal” anatomy is first illustrated with the percentage of patients exhibiting this pattern. Schematic diagrams as well as MIPs from CTAs, DSAs, or MRAs are used to illustrate this. Then, variations are illustrated starting with the most common and ending with rare (<1%) variants. These variants are also well illustrated with diagrams and accompanying clinical images.

In conclusion, knowing only “textbook” arterial anatomy is insufficient for diagnostic and interventional radiologists. This book provides a much-needed overview of anatomic arterial variations. It is well illustrated, has a diversity of illustration modalities, and is concise. No current book is comparable.

What is lacking is commentary on why certain anatomic variations are clinically important. For example, it would be nice for the authors to note not just the frequency of a right-sided aortic arch with a mirror imaging branching pattern and the frequency of a right-sided aortic arch with an aberrant left subclavian artery (each <0.1%), but to add that the former is associated with congenital heart disease 98% of the time, while the latter is only associated 5% of the time. Additionally, a whole chapter is dedicated to the obturator artery. While the book correctly states that this may arise from the external iliac artery in 25% of patients, it does not discuss the clinical importance of this. This anatomic variation is so crucial that it is called the “corona mortis,” which in Latin means “crown of death,” because this variation of the obturator artery is susceptible to trauma (iatrogenic and otherwise) as it courses over the superior pubic ramus.⁴ Despite this limitation, this book would make a great addition to a reading room library or reference in an angiography suite. Medical students, residents, fellows, and attendings in a variety of radiology subspecialties would find this book useful.

References

1. Iqbal S. A comprehensive study of the anatomical variations of the circle of Willis in adult human brains. J Clin Diagn Res 2013;7:2423–27, 10.7860/JCDR/2013/6580.3563
2.  Mamatha H, Hemalatha B, Vinodini P, et al. Anatomical study on the variations in the branching pattern of internal iliac artery. Indian J Surg 2015;77:248–52, 10.1007/s12262-012-0785-0
3. Farghadani M, Momeni M, Hekmatnia A, et al. Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: evaluation with multidetector computed tomography angiography. J Res Med Sci 2016;21:129, 10.4103/1735-1995.196611
4. Al Talalwah W. A new concept and classification of corona mortis and its clinical significance. Chin J Traumatol 2016;19:251–54, 10.1016/j.cjtee.2016.06.004