A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch

Abstract

Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.

An unusual case of asymmetrical combined variations of the subclavian and axillary artery with clinical significance

“…Our case corresponds to type 6 (0.7%). This type seems to have a low incidence in South American (0.2%) and a high incidence in African populations (1.4%) [16]. A median incidence was reported in European populations (0.8%) [16].…”

“…In cases of the ARSCA formation, the regression occurs instead between the 7 th intersegmental artery and the RCCA, so that the RSCA is then connected to the left dorsal aorta via the part of the right dorsal aorta which normally regresses. During growth, the RSCA origin migrates until it is just distal to that of the LSCA [1,10,16,21].…”

“…The variant AOA types have a strong association with some congenital syndromes, such as DiGeorge syndrome, trisomy 13, 18 and 21, tetralogy of Fallot, origin of left coronary artery from the pulmonary artery, congenital polyvalvular disease, oesophageal atresia, and others [16]. In a meta-analysis [16], six types of the left-sided AOA concerning its branching pattern and course were identified: -1 st type -a normal pattern of three branches, BCT-LCCA-LSCA in 80.9%; -2 nd type -the bovine arch, (common trunk of BCT and LCCA originating from the AOA followed by the LSCA) in 13.6%; -3 rd type -the AOA of four branches (BCT-LCCA-LVA-LSCA) with an incidence of 2.9%; -4 th type -a combination of bovine arch and aberrant LVA origin from the AOA in 0.4%; -5 th type -an AOA which gave rise to the RSCA, followed by a bicarotid trunk (common trunk for RCCA and LCCA) and a LSCA, in 0.3%; -6 th type -RCCA and LCCA from the AOA, followed by LSCA and ARSCA with an incidence of 0.7%. Other variants (left and right BCTs, right VA directly from the AOA, four branched AOA, double AOA, etc.)…”

Common Origin of Brachiocephalic and Left Common Carotid Arteries: Proposal of New Terminology

“…1 The reported prevalence of this variant is between 7% and 26%, with the highest prevalence in African and South American populations. 3 This variant has been historically termed the "bovine" arch, yet the origin of this term is not clear. 4 Despite several critiques, 4,5 this term is still in wide use in radiologic and surgical reports and journal publications, 1,2 mainly because it is familiar and shorter than the full anatomic description.…”

“…Moreover, the association of this variant with a separate aortic origin of the left vertebral artery constitutes a different branching variant, which was termed a combined "bovine" arch and direct origin of the left vertebral artery, 3 despite being a 3-rather than the 2-vessel branching pattern suggested by the term "bovine" (Fig 1D). Another rare variant that we recently encountered is a right aortic arch with a common origin of the left brachiocephalic trunk and right common carotid artery, causing confusion about the terminology and raising the question of whether it could be termed a "reverse bovine" arch ( Fig 1E).…”