Aortic Arch Morphology and Aortic Length in Patients with Dissection, Traumatic, and Aneurysmal Disease

Abstract

This study assessed aortic arch morphology and aortic length in patients with dissection, traumatic injury, and aneurysm undergoing thoracic endovascular aortic repair and identified characteristics specific to the different pathologies. We retrospectively evaluated the aortic arch morphology and aortic length of 210 patients (49 dissection, 99 traumatic injury, 62 aneurysm) enrolled in three trials who received the conformable Gore TAG thoracic endoprosthesis. The mean age was 43 ± 19.6 years for trauma patients, 57 ± 11.7 years for dissection patients, and 72 ± 9.6 years for aneurysm patients. A standardized protocol was used to measure aortic arch diameter, length, and take-off angle, and clock-face orientation of branch vessels. Differences in arch anatomy and length were assessed using analysis of variance and independent t-tests. Of the 210 arches evaluated, 22% had arch vessel common trunk configurations. The Table contains highlights of comprehensive measurements. The aortic diameter and the distance from the left main coronary to the left common carotid were greater in dissection patients than in trauma or aneurysm patients (P < .05). The distances from the branch vessels to the celiac artery were greater in dissection and aneurysm patients than in trauma patients (P < .05). Aortic diameter was greater in aneurysm patients compared with trauma patients (P < .05). The take-off angle of the innominate, left common carotid, and left subclavian were greater, between 19% and 36%, in trauma patients than in dissection and aneurysm patients (P < .05). Clock-face orientation of the arch vessels varied between pathologies. Arch anatomy has significant morphologic differences when comparing aortic pathologies. Describing these differences in a large sample of patients is beneficial for device designs and patient selection that plays a critical role in outcomes.TableHighlights of aortic arch measurements in patients with dissection, traumatic, and aneurysmal diseaseMeasurement/studyMeanSDP valueANOVAAortic diameter (mm) 20 mm distal to LMC Trauma30.54.5<.0001 Dissection38.44.8 Aneurysm36.54.9Distance (mm) from LMC to LCC<.0001Trauma103.816.7Dissection126.516.2Aneurysm116.618.4 IA to CA<.0001Trauma244.723.6Dissection280.531.1Aneurysm306.340.1 LCC to CA<.0001Trauma238.422.5Dissection27429Aneurysm298.335.3 CA to LRA0.07Trauma34.712Dissection39.714Aneurysm3912.6Take-off angle at IA, °<.0001 Trauma72.520.5 Dissection56.616 Aneurysm53.916.5Take-off angle at LCC, °<.0001 Trauma64.616.5 Dissection51.613.5 Aneurysm51.411.6Clock position of IA<.0001 Trauma12:3929’ Dissection12:1131’ Aneurysm12:2630’Clock position of LCC<.0001 Trauma12:0421’ Dissection11:4725’ Aneurysm11:5821’ANOVA, Analysis of variance; CA, celiac artery; IA, innominate artery; LCC, left common carotid; LMC, left main coronary; LRA, left radial artery; SD, standard deviation. Open table in a new tab