Clinical and anatomical features of blood supply of parathyroid glands: autopsy case series
https://doi.org/10.14341/serg9637
Abstract
Hypoparathyroidism is the most common complication after surgery on the thyroid gland. All authors confirm the fact that the main cause of hypoparathyroidism is a violation of the blood supply of parathyroid glands, as well as their damage or even accidental removal during surgery. Having analyzed the real cases, and based on our own experience, we came to the conclusion that in order to prevent complications, we will need to study the types of blood supply of the parathyroid glands in details. To this end, we have performed 46 unilateral microdissections and X-ray angiography studies of the arterial supply at 23 organocomplexes of the neck. 42 upper and 43 lower parathyroid glands were detected. It has been established that the main feeding vessel of parathyroid glands is the inferior thyroid artery (type I). The association of glands with the inferior thyroid artery was revealed in 71.8% of cases. A mixed variant of blood supply (simultaneously from the superior and inferior thyroid arteries) was revealed in 14.1% cases (type II). Only 10.6% of the gland were fed isolated from the superior thyroid artery (type III). In addition, in 8.7% cases in the preparations there was no inferior thyroid artery. In 3.5% cases, the connections of the lower parathyroid glands with the thyroid arteries were not reliably detected. Most probably, their feeding was provided at the expense of small collaterals from surrounding organs (type VI).
About the Authors
Viktor Y. MalyugaDistrict City Hospital №2
Russian Federation
MD, PhD
Aleksandr A. Kuprin
A.K. Eramishanzeva City Clinical Hospital
Russian Federation
MD, PhD
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Supplementary files
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1. Table 1. Types of blood supply to the liver | |
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2. Fig. 1. I type. Right lobe SHCHZH: 1, 2 - small branches from the main trunk of NCHA, heading into the pre-tracheal tissue; 3, 4, 5 - branches of the first-order NCHA. RLN is the recurrent laryngeal nerve. a - X-ray angiogram in a direct projection. Contrasted with NSCHA. The artery has many branches. Three main (3, 4, 5) are sent to the thyroid tissue, others, smaller (1, 2) - into the pre-tracheal cell space. Marked with metal tips, NOVES and NOUCH (circled) are in the basin of the NCHA. Contrasted small twigs are sent to the LEL. b - microdissection. The TSS are in a typical place. Vascular "legs" are visualized, reaching the LEL from the branches of the first order NCHA (3, 4, 5). The main stem of the ULN (RLN) is located in front of the NSHA. c is a circuit. | |
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3. Fig. 2. I type. The left part of the thyroid gland: 1, 2 - branches of the first-order NCHA. RLN is the recurrent laryngeal nerve. a - X-ray angiogram in a direct projection. Contrasted with NSCHA. The artery has two main branches of the first order (1, 2), directed to the thyroid tissue. Marked with metal tips, NOVES and NOUCH (circled) are in the basin of the NCHA. Contrast small branches, going to the TERMINAL. Arrow - incisura thyreoidea superior. b - microdissection. The spine is located in a typical place, intimately belonging to the upper branch of the first order of NCHA (2). The BAP is located in the pre-tracheal tissue, to which a third-order branch from the lower branch of the NCHA (1) is directed. The division of VLN (RLN) occurs at the level of the NSAHA behind its branches. c is a circuit. | |
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4. Fig. 3. X-ray angiogram in the direct projection: 1 - posterior anastomosis between NSHA and VSTA; 2 - anterior anastomosis between NSHA and VST. OCA - common carotid artery (partially contrasted). A contrast is introduced into the left NSCHA. Two anastomoses are clearly visualized, located along the posterior (1) and anterolateral surface (2) of the thyroid lobe. II type of blood supply was identified in our work in 12 (14.1%) of the LTR (9 STICKS, 3 NOSHES). | |
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5. Fig. 4. IIa type. The left share SHCHZH. 1, 2, 3 - first-order branches of the first order. RLN is the recurrent laryngeal nerve. a - X-ray angiogram in a direct projection. Contrasted on the left. The artery has three branches of the first order (1, 2, 3), directed to the thyroid tissue. Marked with a metal tip, the NOISE (circumscribed) is located in the course of the posterior anastomosis. The posterior branch of the VHA (3) forms an anastomosis with the upper branch of the NCHA (black arrows). The inter-lobe anastomosis between the left and right OVH (white arrows) is contrasted. b - microdissection. Anterior anastomosis (arrows) was prepared. The branch is in a typical place and receives twigs from the upper third of the anastomosis. The NOSHCH is localized at the lower pole of the thyroid gland and is blood-sucked from the lower branch of the NCHA. VGN is located behind the NSA and is parallel to the posterior anastomosis. c is a circuit. | |
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6. Fig. 5. IIb type. The left share SHCHZH. RLN is the recurrent laryngeal nerve. a is microdissection. Anterior anastomosis is located under the capsule on the anterolateral surface of the thyroid (arrows). STI situated on the anterior anastomosis in the region of the lower third of the anastomosis. b - scheme. | |
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7. Fig. 6. X-ray angiograms of two organocomplexes with anomaly of development of the left NSHA (direct projection). OCA is a common carotid artery. The arrows indicate the direction of the contrast. a, b - at the first stage of the study, it was not possible to identify and cannulate the left NSA. Two organocomplexes with cannulated and contrasted left VSCH. The arrows indicate the spread of contrast to the opposite side with the staining of the right VSTA and NCHA. Left NSA is absent. TSS marked with metal tips. The nutrition is carried out on the side of atresia due to the UPH. | |
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8. Fig. 7. Type III. a - X-ray angiogram in a direct projection. Cannulated and contrasted right and left VSTA (both NSCHA when searching at the first stage of the work are not identified). NSChA is not contrasted on both sides. Marked with metal tips, NOVES and NOUCHES (circled) are located in the basin of the VCHA. b, c - microdissection. The left share SHCHZH. NCHA is absent. The abscess is located on the anterior surface of the thyroid gland under the capsule and is mainly supplied by the anterior branch of the VCHA, which runs along the anterior surface of the thyroid. The spine is located in a typical place and is also blood-sucked by branches of the VL. d - scheme. The left share SHCHZH. | |
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9. Fig. 8. Intraoperative picture of anomaly of development of left NSA. Both TSS (circumcised) are located at the level of the shield-aperture articulation (in midposition) and are blood flowing. | |
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10. Fig. 9. X-ray angiogram in a direct projection. Contrast is introduced in both NSCH. The contrast retrogradno falls in the right and left VSCH and unpaired thyroid artery (arrows). Marked (highlighted) only STICK. NOSHL were low in pre-tracheal tissue and before angiography were not found and not labeled. Their connection with the thyroid arteries with microdissection was not revealed. | |
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11. Fig. 10. Intraoperative finding of unpaired thyroid artery (arrows). BAPTIZH intimately adjoins the trunk of this artery (IV type of blood supply). SHCHZH - the lower pole of the thyroid gland. | |
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12. Table 2. Number of branches of the first and second-order branches | |
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13. Table 3. Order of the branches of the NCHA feeding the LNS | |
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14. Fig. 11. A typical picture of the blood supply of the thyroid gland and the liver. 1 - anterior anastomosis, 2 - posterior anastomosis. I-IV - types of blood supply of the TSS. | |
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For citations:
Malyuga V.Y., Kuprin A.A. Clinical and anatomical features of blood supply of parathyroid glands: autopsy case series. Endocrine Surgery. 2018;12(1):40-54. (In Russ.) https://doi.org/10.14341/serg9637
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