Anatomical variations of aortic arch branching patterns: an evaluation using digital subtraction angiography

Year 2025, Volume: 2 Issue: 1, 9 - 14, 15.02.2025

Mustafa Demir , Şuayip Aslan

https://doi.org/10.70058/cjm.1519956

Abstract

Abstract
Background: Anatomical variations in the aortic arch branching pattern are crucial for planning surgical and endovascular procedures. These variations, often detected incidentally during radiological studies, can influence the approach and success rate of interventions.
Objective: To retrospectively analyze the variations in the aortic arch branching patterns using digital subtraction angiography (DSA) and compare the findings with existing literature.
Methods: A retrospective analysis was conducted on 221 patients who underwent arcus aortography with DSA for neurovascular pathologies at the University of Ümraniye Education and Research Hospital from January 2020 to November 2022. Patients with previous thoracic-vascular surgery were excluded. The aortic arch findings were categorized according to established classifications.
Results: Six distinct aortic arch branching patterns were identified among the 221 patients. The most common type was the normal or classical form (Type 1) found in 78.3% of the patients. Type 2, where the left common carotid artery originates from the brachiocephalic trunk, was observed in 19.9% of the cases. Type 3, characterized by the left vertebral artery originating directly from the aortic arch, was seen in 0.9% of the patients. Other types, including right aortic arch with aberrant right subclavian artery, were less common. Type 3 variations were more prevalent among females, while other variations showed no significant gender difference.
Conclusion: Variations in the aortic arch branching patterns are common and generally asymptomatic but have significant implications for surgical and interventional procedures. Recognizing these variations is essential for improving procedural success rates and reducing complications in neurovascular interventions.

Keywords

Aortic arch, digital subtraction angiography, neurovascular interventions

Ethical Statement

Ümraniye eğitim ve araştırma hastanesi etik kurulu onayı alınmıştır.

Thanks

Değerlendirdiğiniz için teşekkür ediyorum

Aortik ark dal yapılarının anatomik varyasyonları: dijital subtraksiyon anjiyografisi kullanılarak yapılan bir değerlendirme

Abstract

References

• Adachi B (1928) Das arteriensystem der Japaner, vol 1. Kenkyusha, Kyoto, pp 29–41.
• Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature re- view. Surg Radiol Anat 2009;31(5):319-323. doi:10.1007/s00276-008-0442-2
• Nayak RS, Pai MM, Prabhu LV, D’Costa S, Shetty P (2006) Anatomical organization of aortic arch variations in India: embryological basis and review. J Vasc Bras 5:95–100.
• Bhatia K, Ghabriel MN, Henneberg M (2005) Anatomical variations in the branches the human aortic arch: a recent study of a South Australian population. Folia Morphol (Warsz) 64(3):217-223.
• Alsaif HA, Ramadan WS (2010) An anatomical study of the aortic arch variations. JKAU Med Sci 17(2):37-54.
• Liechty JD, Shields TW, Anson BJ (1957) Variations pertaining to the aortic arches and their branches. Q Bull Northwest Univ Med Sch 1957;31(2):136–143.
• Hornick M, Moomiaie R, Mojibian H, et al. ‘Bovine’ aortic arch - a marker for thoracic aortic disease. Cardiology. 2012;123(2):116-124. doi:10.1159/000342071
• Snelling BM, Sur S, Shah SS, Chen S, Menaker SA, McCarthy DJ, et al. Unfavorable vascular anatomy is associated with increased revascularization time and worse outcome in anterior circulation thrombectomy. World Neurosurg 2018;120:e976-e983.doi:10.1016/j.wneu.2018.08.207
• Terzioğlu E, Damar Ç. Evaluation of aortic arch morphologies by computed tomographic angiography in Turkish population. Turk Gogus Kalp Damar Cerrahisi Derg. 2022;30(2):167-175. doi:10.5606/tgkdc.dergisi.2022.22474
• Berko NS, Jain VR, Godelman A, Stein EG, Ghosh S, Haramati LB. Variants and anomalies of tho- racic vasculature on computed tomographic angiography in adults. J Comput Assist Tomogr 2009;33:523-8. doi:10.1097/ RCT.0b013e3181888343
• Goray VB, Joshi AR, Garg A, Merchant S, Yadav B, Maheshwari P. Aortic arch variation: a unique case with anomalous origin of both vertebral arteries as additional branches of the aortic arch distal to left subclavian artery. AJNR Am J Neuroradiol. 2005;26(1):93-95.
• Lu J, Ebraheim NA. The vertebral artery: surgical anatomy. Orthopedics. 1999;22(11):1081-1085. doi:10.3928/0147-7447- 19991101-17
• Popieluszko P, Henry BM, Sanna B, et al. A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vasc Surg. 2018;68(1):298-306.e10. doi:10.1016/j.jvs.2017.06.097
• Ehren H, Wells TR, Landing BH. Association of common origin of the carotid arteries with anomalous origin of the left coronary artery from the pulmonary artery. Pediatr Pathol. 1985;4(1- 2):59-66. doi:10.3109/15513818509025903
• Levitt B, Richter JE. Dysphagia lusoria: a comprehensive review. Dis Esophagus. 2007;20(6):455-460. doi:10.1111/j.1442- 2050.2007.00787.x
• Fazan VPS, Ribeiro RA, Ribeiro JAS, Filho OAR (2000) Right retroesophageal subclavian artery. Acta Cir Bras 18:54–56.
• Demetriades D. An unusual anatomical aortic arch variation. J Trauma. 2005;58(3):654. doi:10.1097/01. ta.0000140252.32867.8a
• Ergun E, Şimşek B, Koşar PN, Yılmaz BK, Turgut AT. Anatomical variations in branching pattern of arcus aorta: 64-slice CTA appearance. Surg Radiol Anat. 2013;35(6):503-509. doi:10.1007/s00276-012-1063-3
• Patil ST, Meshram MM, Kamdi NY, Kasote AP, Parchand MP. Study on branching pattern of aortic arch in Indian. Anat Cell Biol. 2012;45(3):203-206. doi:10.5115/acb.2012.45.3.203