Kugel's artery

Last revised by Andrew Murphy on 30 Apr 2020

Citation, DOI, disclosures and article data

Citation:

Carroll D, Murphy A, Knipe H, Kugel's artery. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-66508

DOI:

https://doi.org/10.53347/rID-66508

Permalink:

https://radiopaedia.org/articles/66508

rID:

66508

Article created:

22 Feb 2019, David Carroll ◉

Disclosures:

At the time the article was created David Carroll had no recorded disclosures.

View David Carroll's current disclosures

Last revised:

30 Apr 2020, Andrew Murphy ◉

Disclosures:

At the time the article was last revised Andrew Murphy had no recorded disclosures.

View Andrew Murphy's current disclosures

Revisions:

3 times, by 3 contributors - see full revision history and disclosures

Systems:

Cardiac

Sections:

Anatomy

Tags:

coronary, coronary artery, cases

Synonyms:

Arteria anastomotica auricularis magna
Kugel artery

An uncommon variant of coronary arterial anatomy, Kugel's artery was originally described as an anastomotic communication between branches of the proximal left circumflex artery with the distal right coronary artery. These coronary trunks often communicate indirectly through atrial anastomotic networks; Kugel's artery is distinguished by its size and characteristic course ³.

Initially described as the “arteria anastomotica auricularis magna” due to its relatively large luminal diameter and its perceived role as a crucial component of the coronary circulation. The eponym now refers to an artery which connects the proximal left circumflex or right coronary artery with the distal right coronary or left circumflex artery.

Epidemiology

Its reported incidence differs between studies, with one recent publication noting its presence in 6% of the population. It originated from the proximal left circumflex artery and ended in the right coronary artery in two patients; from the right coronary artery and ended in the same artery in a further two patients; from the left circumflex artery and ended in the same artery in one patient; and from the right coronary artery through the sinus node artery, ending in the left circumflex artery, in one. Of note, a collection of more diminutive vascular anastomoses in the interatrial septum is usually present, which connects the coronary trunks in the absence of a distinct Kugel's artery ¹.

Gross anatomy

Origin

left circumflex artery (LCx)
- most common variant proximal LCx to distal right coronary artery
- less commonly will end in the distal LCx
right coronary artery (RCA)
- most commonly terminating in a more distal segment of right coronary artery
- may also communicate with the left circumflex artery via the sinoatrial nodal artery

Course

After branching from the LCx or RCA, Kugel's artery first traverses the atrioventricular groove posterior to the aortic root, subsequently travelling within the basal interatrial septum. It will then cross the septum adjacent to its attachment with the membranous interventricular septum. Its position in relation to the aortic root and the direction which it crosses the interatrial septum to meet its point of anastomosis is based on the vessel's origin and termination ¹.

Variant anatomy

Variable branching patterns can be present:

anastomosis with the right coronary artery
- will course posterior and to the right of the orifice of the coronary sinus
- meets the distal right coronary artery several millimetres to the right of the crux
anastomosis with the left circumflex artery
- will travel inferoposteriorly in relation to the orifice of the coronary sinus
- terminates in the circumflex several millimetres to the left of the crux