Arterial Blood Supply to the Parathyroids

On the basis of the study of 357 parathyroid gland pedicles, Flament and colleagues14 found a single artery supplying the parathyroids in 80% of the cases. This artery was simple in 65% of the cases, bifurcated before its entry into the gland in 30%, and divided into three branches in 5%. In 15% of the total group, two distinct arteries were observed, in 4% three were seen, and in 1 %, even four separate arteries were found.

The length of the artery is variable, usually between 8 and 12 mm. When long, the arteries are commonly tortuous; when the pedicle is short, it holds the parathyroid hard against its vessel of origin. Generally, pedicles of the superior parathyroid are shorter than those of the inferior ones. Both the superior and inferior parathyroid glands most frequently borrow their blood supply from the inferior thyroid artery. In particular, superior parathyroid glands receive their arterial blood supply from this artery in approximately 80% of the cases. In 15%, the blood supply is provided by the superior thyroid artery, and in 5%, by anastomoses running between the two systems. When the superior thyroid artery supplies the superior parathyroid, the supply almost always comes from the posterior branch or from an artery arising from the posterior branch and destined for the esophagus or the larynx. In approximately 10% of the cases, inferior parathyroid glands are vascularized by the superior thyroid artery, anastomosis of both systems, or Neubauer's artery.14 This figure is intimately related to the frequency of agenesis of the inferior thyroid artery, which occurs in 1% to 6% of cases.

In terms of parathyroid blood supply, certain practical observations are worthwhile. A special tiny parathyroid artery always supplies the gland and is considered terminal. Superior and inferior parathyroid arteries usually arise from the glandular branch of the thyroid artery but can often arise from the muscular or the esophageal branches. They can also originate from an anastomosing channel between the inferior and superior thyroid vessels. Very few, if any, vascular connections between the parathyroid glands and the adjacent connective tissue normally exist. The fine branches that the parathyroid arteries give off to the surrounding fat end in the fatty tissue, thus making it easier to enucleate the glands with their involved fat than to liberate them from it.314

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