Anatomical Variations of the Aortic Arch: A Computerized Tomography-Based Study

Abstract

Introduction Despite adequate preparation and meticulous pre-operative assessment, variations of the vascular anatomy of the aortic arch may lead to clinical dilemmas. In the present era, with the easy availability of imaging facilities, various anatomical variations can be found out prior to an interventional procedure. However, there are many countries including India where such facilities may still be not widely available. The purpose of this study was to assess the prevalence of these anatomical variants in patients undergoing Computerised Tomography (CT) chest with contrast. Methods This observational study involved patients who underwent CT chest with contrast as part of various clinical indications during a three-year period in a tertiary care centre in South India. Variations of the aortic arch and its branching pattern were studied in 4,000 chest CT images of patients referred to the radiology department. Results A total of 4,000 patients underwent CT chest with contrast during the study period. Twenty-seven variations were observed in these patients. They included aberrant right subclavian artery in seven patients, bovine arch in one patient, bovine origin of left vertebral artery from arch in one patient, bronchial artery of anomalous origin from arch in one patient, double aortic arch in one patient, and right-sided aortic arch in 16 patients. Conclusion The variant anatomy of the aortic arch has tremendous clinical significance, especially from the surgical standpoint. Anatomical variants can also cause difficulty during catheterization while performing endovascular interventions. Given the prevalence demonstrated in our study, imaging may be indicated prior to any procedure involving vascular access in order to prevent unwanted complications.

Balanced Double Aortic Arch Causing Acute Tracheal Compression

“…The double aortic arch (DAA) is an uncommon congenital anomaly caused by the persistence of a right aortic arch forming with the left aortic arch a complete vascular ring around the trachea and esophagus causing its compression. 1 …”

“…It was first described by Wolman in 1939, 2 and represents 46% to 76% of complete vascular rings, and 0.8% to 2% of all congenital cardiovascular malformations. 1 , 3 …”

“…In case of failure of involution of the right arch, and persistence of the left arch a double aortic arch is formed creating a vascular ring around the trachea and esophagus, and joining together to the descending aorta. 1 , 2 , 4 …”

“…The double aortic arch (DAA) is an uncommon congenital anomaly caused by the persistence of a right aortic arch forming with the left aortic arch a complete vascular ring around the trachea and esophagus causing its compression. 1 It was first described by Wolman in 1939, 2 and represents 46% to 76% of complete vascular rings, and 0.8% to 2% of all congenital cardiovascular malformations. 1,3 In organogenesis, 6 pairs of aortic arches develop at different stages: the first 2 arches regress forming the maxillary, hyoid, and stapedial arteries.…”

“…1 It was first described by Wolman in 1939, 2 and represents 46% to 76% of complete vascular rings, and 0.8% to 2% of all congenital cardiovascular malformations. 1,3 In organogenesis, 6 pairs of aortic arches develop at different stages: the first 2 arches regress forming the maxillary, hyoid, and stapedial arteries. The third pair forms the common carotid artery and part of the internal carotid artery.…”