open access
Morphometry of the aortic arch and its branches. A computed tomography angiography-based study
Affiliations- Human Anatomy Department, School of Medicine, Universidad Autónoma de Nuevo León, Mexico
- Radiology and Diagnostic Imagining Department, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Mexico
open access
Abstract
Background: The current study aims to determine the prevalence of variations of the aortic arch using computed tomography angiography (CTA), as well as morphometries and gender correlations.
Materials and methods: A retrospective, transverse, observational and descriptive study of 220 CTA was performed. The branching pattern, most cranial vertebral level of the aortic arch, area of the proximal, middle and distal segments of the arch, area of each branch, and the path of atypical arteries were recorded. Results were analysed and stratified by gender.
Results: The typical aortic arch branching pattern was present in 77.7% without statistical significance between genders. The most common variant was a two-branch pattern with a common trunk and a left subclavian (13.6%), followed by a typical branching pattern with an added left vertebral artery (7.3%). T3 was the most frequent cranial level (32.3%), followed by T2–T3 (26.8%), and T3–T4 (23.2%). The mean areas of the aortic arch were 685.5 ± 183.9, 476.1 ± 124.1, and 445.0 ± 145.1 mm2 for the proximal, middle and distal segments, with statistical difference between men and women in the middle and distal segments. Three paths of atypical arteries were identified: bifurcated vertebral artery (0.5%), aberrant right subclavian artery (0.5%), and left subclavian ostium obstruction (0.5%).
Conclusions: Mexican population has one of the highest prevalence of variations in the aortic arch branching pattern. The high probability of finding these should be taken into consideration when assessing patients. A standardised classification method would contemplate future un-reported findings, without causing confusion by the different numbers assigned by each author.
Abstract
Background: The current study aims to determine the prevalence of variations of the aortic arch using computed tomography angiography (CTA), as well as morphometries and gender correlations.
Materials and methods: A retrospective, transverse, observational and descriptive study of 220 CTA was performed. The branching pattern, most cranial vertebral level of the aortic arch, area of the proximal, middle and distal segments of the arch, area of each branch, and the path of atypical arteries were recorded. Results were analysed and stratified by gender.
Results: The typical aortic arch branching pattern was present in 77.7% without statistical significance between genders. The most common variant was a two-branch pattern with a common trunk and a left subclavian (13.6%), followed by a typical branching pattern with an added left vertebral artery (7.3%). T3 was the most frequent cranial level (32.3%), followed by T2–T3 (26.8%), and T3–T4 (23.2%). The mean areas of the aortic arch were 685.5 ± 183.9, 476.1 ± 124.1, and 445.0 ± 145.1 mm2 for the proximal, middle and distal segments, with statistical difference between men and women in the middle and distal segments. Three paths of atypical arteries were identified: bifurcated vertebral artery (0.5%), aberrant right subclavian artery (0.5%), and left subclavian ostium obstruction (0.5%).
Conclusions: Mexican population has one of the highest prevalence of variations in the aortic arch branching pattern. The high probability of finding these should be taken into consideration when assessing patients. A standardised classification method would contemplate future un-reported findings, without causing confusion by the different numbers assigned by each author.
Keywords
aortic arch, anatomical variants, branching pattern, Mexico
About this articleTitle
Morphometry of the aortic arch and its branches. A computed tomography angiography-based study
Journal
Issue
Article type
Original article
Pages
575-582
Published online
2020-08-22
Page views
7169
Article views/downloads
1395
DOI
Pubmed
Bibliographic record
Folia Morphol 2021;80(3):575-582.
Keywords
aortic arch
anatomical variants
branching pattern
Mexico
Authors
M. Tapia-Nañez
G. A. Landeros-Garcia
M. A. Sada-Treviño
R. Pinales-Razo
A. Quiroga-Garza
B. A. Fernandez-Rodarte
R. E. Elizondo-Omaña
S. Guzman-Lopez
References (28)- Acar M, Ulusoy M, Zararsiz I, et al. Anatomical variations in the branching of human aortic arch. Biomed Res India. 2013; 24(4): 531–535.
- Allen D, Bews H, Vo M, et al. Arteria lusoria: an anomalous finding during right transradial coronary intervention. Case Rep Cardiol. 2016; 2016: 8079856.
- Alsaif H, Ramadan W. An anatomical study of the aortic arch variations. JKAU Med Sci. 2010; 17(2): 37–54.
- Budhiraja V, Rastogi R, Jain V, et al. Anatomical variations in the branching pattern of human aortic arch: a cadaveric study from central India. ISRN Anat. 2013; 2013: 828969.
- De Garis CF, Black IH, Riemenschneider EA. Patterns of the aortic arch in american white and negro stocks, with comparative notes on certain other mammals. J Anat. 1933; 67(Pt 4): 599–619.
- Dumfarth J, Chou AS, Ziganshin BA, et al. Atypical aortic arch branching variants: A novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg. 2015; 149(6): 1586–1592.
- Grande NR, Costa eS, Pereira AS, et al. Variations in the anatomical organization of the human aortic arch. A study in a Portuguese population. Bull Assoc Anat (Nancy). 1995; 79(244): 19–22.
- Herrera Ortiz NE, Ballesteros Acuña LE, Forero Porras PL. Caracterizacion de las Ramas del Arco Aórtico en una Muestra de Poblacion Colombiana: Un Estudio con Material de Autopsia. Int J Morphol. 2012; 30(1): 49–55.
- Huapaya JA, Chávez-Trujillo K, Trelles M, et al. Anatomic variations of the branches of the aortic arch in a Peruvian population. Medwave. 2015; 15(6): e6194.
- Isser HS, Garg G. Arteria lusoria: A challenge for transradial coronary interventionist. IHJ Cardiovascular Case Reports (CVCR). 2020; 4(1): 7–9.
- Jakanani GC, Adair W. Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol. 2010; 65(6): 481–487.
- Jalali Kondori B, Asadi MH, Rahimian E, et al. Anatomical variations in aortic arch branching pattern. Arch Iran Med. 2016; 19(1): 72–74.
- Kahn C, MacNeil M, Fanola C, et al. Complex arterial patterning in an anatomical donor. Transl Res Anat. 2018; 12: 11–19.
- Makhanya NZ, Mamogale RT, Khan N. Variants of the left aortic arch branches. S Afr J Radiol. 2004; 8(4): 10.
- McDonald J, Anson B. Variations in the origin of arteries derived from the aortic arch, in American whites and negroes. Am J Phys Anthropol. 1940; 27(1): 91–107.
- Mustafa AG, Allouh MZ, Ghaida JH, et al. Branching patterns of the aortic arch: a computed tomography angiography-based study. Surg Radiol Anat. 2017; 39(3): 235–242.
- Natsis KI, Tsitouridis IA, Didagelos MV, et al. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat. 2009; 31(5): 319–323.
- Patil ST, Meshram MM, Kamdi NY, et al. Study on branching pattern of aortic arch in Indian. Anat Cell Biol. 2012; 45(3): 203–206.
- 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.
- Prada G, Granados AM, Calle JS, et al. Anatomic variations of the aortic arch depicted on 444 CT angiographies. Eur J Anat. 2016; 20(2): 137–141.
- Rojas M, Muete W, Quijano Y. Anatomical variations of the aortic arch in a sample of Colombian population. Revista de la Facultad de Medicina. 2017; 65(1): 49–54.
- Shiva Kumar GL, Pamidi N, Somayaji SN, et al. Anomalous branching pattern of the aortic arch and its clinical applications. Singapore Med J. 2010; 51(11): e182–e183.
- St Gielecki J, Wilk R, Syc B. Digital-image analysis of the aortic arch’s development and its variations. Folia Morphol. 2004; 63: 449–454.
- Tawfik AM, Sobh DM, Ashamallah GA, et al. Prevalence and types of aortic arch variants and anomalies in congenital heart diseases. Acad Radiol. 2019; 26(7): 930–936.
- Valsecchi O, Vassileva A, Musumeci G, et al. Failure of transradial approach during coronary interventions: anatomic considerations. Catheter Cardiovasc Interv. 2006; 67(6): 870–878.
- Vučurević G, Marinković S, Puškaš L, et al. Anatomy and radiology of the variations of aortic arch branches in 1,266 patients. Folia Morphol. 2013; 72(2): 113–122.
- Wang L, Zhang J, Xin S. Morphologic features of the aortic arch and its branches in the adult Chinese population. J Vasc Surg. 2016; 64(6): 1602–1608.e1.
- Yeri L, Gómez J, Fontaneto S, et al. Variation of the origin of aortic arch branches: in relationship with plates of atheroma. Int J Morphol. 2011; 29(1): 182–186.
