Multidetector Computed Tomography Evaluation of Anomalies of Aortic Arch Branching
DOI:
https://doi.org/10.48165/12s4yt43Keywords:
Multidetector Computed Tomography, Anomalies, Aortic ArchAbstract
Background: Anatomic variations in the branching pattern of the aortic arch is known for a long time. Advances in modern medicine have led to an increasing number of endovascular and vascular reconstructive procedures where the pre-procedural information about these variations is extremely important. Besides, these variations may serve as a marker of thoracic aortic disease. Hence, we tried to evaluate the incidence of these anatomic variations in the branching of the aortic arch utilizing routine contrast-enhanced computed tomography of the thorax (CECT-Th) rather than aortograms. The aims and objectives is to the main aim of the study was to evaluate the role of multidetector routine CECT-Th in the detection of anomalies of branching of the aortic arch along with an estimation of their incidences. Subjects & Methods: Three-hundred and fifty CECT-Th examinations were included in our study over some time with the exclusion of 27 examinations. The type of aortic arch branching pattern was noted, and their incidence was calculated. Results: Majority of the patients in our study were in 41-60yrs age group with male predominance. Majority of the patients had three branches arising from the arch of aorta. The commonest variant was bovine type (14.2%) where the left common carotid arises from the right brachiocephalic artery followed by the isolated vertebral artery and aberrant right subclavian artery in the decreasing order of frequency. Conclusion: Anomalies of branching of aortic arch can be optimally detected on routine CECT-Th examinations performed on a multidetector CT scanner. Anomalies are seen in nearly one-fifth to one-quarter of subjects with the bovine type being the commonest and aberrant right subclavian artery being the rarest.
References
1. Bhatia K, Ghabriel MN, Henneberg M. Anatomical variations in the branches of the human aortic arch: a recent study of a South Australian population. Folia Morphol. 2005;64(3):217– 240.
2. Kumar S, Pamidi GL, Somayaji N, Nayak SN, Vollala S, R V. Anomalous branching pattern of the aortic arch and its clinical applications. Singapore Med J. 2010;51(11):182–185.
3. 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 review. Surg Radiol Anat. 2009;31:319–323. Available from: https://dx.doi.org/10.1007/s00276-008-0442- 2.
4. Dumfarth J, Chou AS, Ziganshin BA, Bhandari R, Peterss S, Tranquilli M, et al. Atypical aortic arch branching variants: A novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg. 2015;149(6):1586–1592. Available from: https://dx.doi. org/10.1016/j.jtcvs.2015.02.019.
5. Jakanani GC, Adair W. Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol. 2010;65(6):481–487. Available from: https://dx.doi.org/10. 1016/j.crad.2010.02.003.
6. Popieluszko P, Henry BM, Sanna B, Hsieh WC, Saganiak K, Pękala PA, et al. A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vas Surg. 2018;68(1):298–306. Available from: https://dx.doi.org/ 10.1016/j.jvs.2017.06.097.
7. Moorehead PA, Kim AH, Miller CP, Kashyap TV, Kendrick DE, Kashyap VS. Prevalence of Bovine Aortic Arch Configuration in Adult Patients with and without Thoracic Aortic Pathology. Ann Vasc Surg. 2016;30:132–137. Available from: https://dx.doi.org/10.1016/j.avsg.2015.05.008.
8. Clerici G, Giulietti E, Babucci G, Chaoui R. Bovine aortic arch: clinical significance and hemodynamic evaluation. J Matern Fetal Neonatal Med. 2018;31(18):2381–2387. Available from: https://dx.doi.org/10.1080/14767058.2017.1342807.
9. Syperek A, Angermaier A, Kromrey ML, Hosten N, Kirsch M. The so-called “bovine aortic arch”: a possible biomarker for embolic strokes? Neuroradiol. 2019;61(10):1165–1172. Avail able from: https://dx.doi.org/10.1007/s00234-019-02264-3.
10. Alsaif H, Ramadan W. An Anatomical Study of the Aortic Arch Variations. J King Abdulaziz Uni -Med Sci. 2010;17(2):37–54. Available from: https://dx.doi.org/10.4197/med.17-2.4.
11. Einstein EH, Song LH, Villela NL. Anomalous Origin of the Left Vertebral Artery from the Aortic Arch. Aorta (Stamford). 2016;4(2):64–67. Available from: https://dx.doi.org/10.12945/ j.aorta.2015.15.022.
12. Dudich K, Bhadelia R, Srinivasan J. Anomalous vertebral artery origin may be an independent risk factor for arterial dissection. Eur J Neurol. 2005;12(7):571–572. Available from: https://dx.doi.org/10.1111/j.1468-1331.2005.01014.x.
13. Polednak AP. Prevalence of the aberrant right subclavian artery reported in a published systematic review of cadaveric studies: The impact of an outlier. Clin Anat. 2017;30(8):1024–1028. Available from: https://dx.doi.org/10.1002/ca.22905.
14. Choi Y, Chung SB, Kim MS. Prevalence and Anatomy of Aberrant Right Subclavian Artery Evaluated by Computed Tomographic Angiography at a Single Institution in Korea. J Korean Neurosurg Soc. 2019;62(2):175–182. Available from: https://doi.org/10.3340/jkns.2018.0048.
15. Jahnke T, Schaefer PJ, Heller M, Mueller-Huelsbeck S. Interventional Management of Massive Hemothorax Due to Inadvertent Puncture of an Aberrant Right Subclavian Artery. Cardiovasc Intervent Radiol. 2008;31(S):124–127. Available from: https://dx.doi.org/10.1007/s00270-007-9177-4.
