Anatomical Variations in Aortic Arch Branching Pattern: A Computed Tomography Angiography Study

Abstract

Introduction: Variations in the branching pattern of the aortic arch (AA) are common. Modification of intravascular stents should be considered taking into account these AA branching variations. Identification of supra-aortic branching types and frequencies is important for specialists planning surgery in this region. In endovascular interventions to the AA, aortic stent grafts should be modified according to the variations of the branching patterns of the AA. In any surgical intervention to the region where the supraaortic branches are located, ignorance of the variations may cause unwanted injuries or complications.Methods: In this study, 699 computed tomography angiography (CTA) images were reviewed to investigate AA branching variations using the Horos software (an open-source image viewer). Four groups were constructed based on the number of branches emerging from the aortic arch, which were further divided into subtypes.Results: A total of 699 CTA images from 320 males and 379 females were included in this study. The usual AA branching pattern (type 3b1) was found in 68.5% of the patients. The combined prevalence of other eight branching patterns, designated as variations, was 31.5%. Variation types 1b1, 3b2, and 4b5 were identified in one patient each. Overall, types 2b1 and 2b2 had a prevalence of 28.3%. The type 2b3 variation was observed in 1.6% of the patients. The least common variations were type 4b1 (0.7%) and type 3b2 (0.1%). Conclusion:The identification of variations in AA branching patterns by CTA prior to surgical or endovascular interventions involving the aortic arch is important. Thus, specialists planning interventions in this region need to be aware and have knowledge of atypical aortic branching patterns. Higher prevalence rates of AA branching patterns compared to previous studies were identified in the Turkish population in this study and therefore, a comprehensive, multicenter study is needed to determine the cause of this differential finding.

Clinical Characteristics and Outcomes of Aortic Arch Emergencies: Takayasu Disease, Fibromuscular Dysplasia, and Aortic Arch Pathologies: A Retrospective Study and Review of the Literature

“…There are many different mechanisms behind aortopathies, like the bicuspid aortic valve, inflammatory diseases, FMD, and heritable connective tissue disorders (e.g., Ehlers–Danlos syndrome) [ 56 , 57 ]. It has been reported that bovine arch variation is associated with the occurrence of aneurysms or type B aortic dissection [ 57 ], as well as with an early age at stroke presentation (on average, 53 years old), compared to normal branching pattern (61 years) [ 18 ]. Furthermore, type B dissections, such as the one in our present study, often occur in patients with normal-sized or only mildly enlarged aortae, and, therefore, are unpredictable [ 46 ].…”

“…Furthermore, type B dissections, such as the one in our present study, often occur in patients with normal-sized or only mildly enlarged aortae, and, therefore, are unpredictable [ 46 ]. Malformative pathology of the aorta is often associated with congenital and/or valve diseases [ 56 , 57 ]. Aortic dissection and rupture are often consequences of disturbed shear stress.…”

“…Many of the signs and symptoms of TAK, FMD, and AAP are nonspecific, such as recurrent headaches, ocular disturbances, dysphagia, shortness of breath, and syncope [ 1 , 2 , 3 ]. This might require more diagnostic work-ups, but also should awaken awareness [ 4 , 8 , 13 , 57 ]. However, there continues to be an unacceptably long delay in the diagnosis of TAK, which is estimated at 2 to 3 years, and FMD, with an average delay of 4 to 9 years [ 1 , 2 , 60 ].…”