Branching Pattern Of Arch Research Articles

Common ostial origin of right subclavian artery and bicarotid trunk in two branch vessel left aortic archRare aortic arch branching pattern

Common ostial origin of right subclavian artery and bicarotid trunk in two branch vessel left aortic archRare aortic arch branching pattern

Persistent median artery and communicating branch related to the superficial palmar arch

Microvascular surgery, plastic and reconstructive hand surgery, and coronary artery bypass surgery call for a microanatomical study of the branching pattern of the superficial palmar arch (SPA). For the anatomical analysis, we used a group of 20 dissected human hands injected with 4% formaldehyde solution and a 10% mixture of melted gelatin and India ink. The morphometric study was performed on 40 human hands of adult persons injected with methyl-methacrylate fluid into the ulnar and radial arteries simultaneously and afterwards corroded in 40% KOH solution for the preparation of corrosion cast specimens. The mean diameter of the SPA, between the second and third common palmar digital arteries, was 1.86 ± 0.08 mm. We identified the persistent median artery (PMA) in 5% of hands. We distinguished the three main groups of the SPAs according to variations in morphology and branching of the arch: Type 1, the long SPA; Type 2, the middle length SPA; and Type 3, the short SPA found in 27.5% of specimens. The communicating branch (CB), a vessel interconnecting the SPA to the closest branch of the radial artery, is classified into two different morphological groups. The third type of incomplete short arterial arch is the most important of the three groups of SPAs. That short SPA is potentially inadequate for restoring circulation after occlusion or radial artery harvesting for coronary artery bypass.

Morphology of the aortic arch branching pattern in raccoon dogs (Nyctereutes procyonoides, Gray, 1834).

Aortic arch (AA) branching patterns vary among different mammalian species. Most previous studies have focused on dogs, whereas those on raccoon dogs remain unexplored. The objective of this study was to describe the AA branching pattern in raccoon dogs and compare their morphological features with those of other carnivores. We prepared silicone cast specimens from a total of 36 raccoon dog carcasses via retrograde injection through the abdominal aorta. The brachiocephalic trunk (BCT) branching patterns were classified based on the relationship between the left and right common carotid arteries. The subclavian artery (SB) branching pattern was examined based on the order of the four major branches: the vertebral artery (VT), costocervical trunk (CCT), superficial cervical artery (SC), and internal thoracic artery (IT). In most cases (88.6%), the BCT branched off from the left common carotid artery and terminated in the right common carotid and right subclavian arteries. In the remaining cases (11.4%), the BCT formed a bicarotid trunk. The SB exhibited various branching patterns, with 26 observed types. Based on the branching order of the four major branches, we identified the main branching pattern, in which the VT branched first (98.6%), the CCT branched second (81.9%), the SC branched third (62.5%), and the IT branched fourth (52.8%). The AA branching pattern in raccoon dogs exhibited various branching patterns with both similarities and differences compared to other carnivores.

Factors associated with the laterality of Cardio-Embolic stroke

ObjectiveUnderstanding the lateralization factors, including the anatomic and hemodynamic mechanisms, is essential for diagnosing cardio-embolic stroke. This study aims to investigate the elements, for the first time together, that could affect the laterality of stroke. MethodsWe performed a monocentric retrospective case-control study based on prospective registries of acute ischemic stroke patients in the comprehensive stroke center of the RWTH University hospital of Aachen for three years (June 2018–June 2021). We enrolled 222 patients with cardioembolic stroke (136 left stroke and 86 right stroke) admitted for first-ever acute ischemic stroke with unilateral large vessel occlusion of the anterior circulation. The peak systolic velocity (PSV) asymmetry of middle cerebral artery (MCA) was assessed by doppler as well as internal carotid artery (ICA) angle, aortic arch (AA) branching pattern and anatomy were assessed by CT-Angiography. ResultsWe found that the increasing left ICA angle (p = 0.047), presence of bovine type AA anatomy (p = 0.041) as well as slow PSV of the right MCA with a value of >15% than left (p = 0.005) were the predictors for left stroke lateralization, while the latter was an independent predictor for the left stroke (OR=3.341 [1.415–7.887]). Inter-Rater Reliability ranged from moderate to perfect agreement. ConclusionThe predictors for left stroke lateralization include the higher values of left ICA angle, presence of the bovine type AA and the slow right MCA PSV.

Does Aortic Arch Anatomy Affect Stroke Laterality in Transcatheter Aortic Valve Implantation?

Background. Current data reveal a predominace of left as opposed to right-sided cerebral strokes after transcatether aortic valve replacement (TAVR). Aortic arch variations might raise the likelihood of cardioembolic particles entering predominantly the left cerebral circulation during catheter tracking and manipulation. Aim. We sought to analyse the impact of aortic arch anatomy on stroke laterality (right vs. left) in patients undergoing TAVR. Methods. All patients who developed a symptomatic, periprocedural left- or right-sided ischemic stroke after TAVR between June 2007 and August 2022 were included in this study. Multislice computed tomography (MSCT) analysis was used to assess aortic arch anatomy, arch configuration (types I–III), arch tortuosity, and the determination of the take-off angles of the supraaortic arteries. Results. The final study cohort comprised 77 patients. Periprocedural ischemic stroke was left-sided in 66.2% of the patients (n = 51) and right-sided in 33.8% (n = 26) (p = 0.006). MSCT analysis revealed a standard aortic arch branching pattern in 70.1% (n = 54) and a common origin of the brachiocephalic and left common arteries (bovine arch anatomy) in 29.9% (n = 23) of the patients. There was no association between the anatomical variations of the aortic arch and stroke laterality p = 0.601 . Frequency of arch configuration types was 15.6% (type I), 74.0% (type II), and 10.4% (type III). There was no correlation between the different types of configuration and the laterality of periprocedural stroke (type I: p = 0.526 , type II: p = 0.585 , and type III: p = 1.000 ). Aortic arch tortuosity and angulation of the supraaortic arteries did also not differ between right- and left-sided strokes. Conclusion. Our data add evidence that there is a significant propensity for left-hemispheric strokes in patients undergoing TAVR. However, MSCT analysis in our cohort did not reveal an association between aortic arch geometry and laterality of stroke.

Anatomical Variations in Aortic Arch Branching Pattern: A Computed Tomography Angiography Study.

Variations in the branching pattern of the aortic arch (AA) are common. Modification of intravascular stents should be considered taking into account these AA branching variations. Identification of supra-aortic branching types and frequencies is important for specialists planning surgery in this region.In endovascular interventions to the AA, aortic stent grafts should be modified according to the variations of the branching patterns of the AA.In any surgical intervention to the region where the supra-aortic branches are located, ignorance of the variations may cause unwanted injuries or complications. In this study, 699 computed tomography angiography (CTA) images were reviewed to investigate AA branching variations using the Horos software (an open-source image viewer). Four groups were constructed based on the number of branches emerging from the aortic arch, which were further divided into subtypes. A total of 699 CTA images from 320 males and 379 females were included in this study. The usual AA branching pattern (type 3b1) was found in 68.5% of the patients. The combined prevalence of other eight branching patterns, designated as variations, was 31.5%. Variation types 1b1, 3b2, and 4b5 were identified in one patient each. Overall, types 2b1 and 2b2 had a prevalence of 28.3%. The type 2b3 variation was observed in 1.6% of the patients. The least common variations were type 4b1 (0.7%) and type 3b2 (0.1%). The identification of variations in AA branching patterns by CTA prior to surgical or endovascular interventions involving the aortic arch is important. Thus, specialists planning interventions in this region need to be aware and have knowledge of atypical aortic branching patterns. Higher prevalence rates of AA branching patterns compared to previous studies were identified in the Turkish population in this study and therefore, a comprehensive, multicenter study is needed to determine the cause of this differential finding.

Anatomical Variations of Branching Pattern of the Arch of Aorta: A Cadaveric Cross-sectional Study

Introduction: The arch of the aorta normally gives off three major branches from its convex surface. Variations in the branching pattern of the Aortic Arch (AA) are not uncommon. Knowledge of these variations is crucial during aortic instrumentation and thoracic or neck surgeries. Aim: This study aimed to investigate the anatomical variations in the branching pattern of the AA in perinatal and adult cadavers. Materials and Methods: A cross-sectional cadaveric study was conducted in the Department of Anatomy, at Assam Medical College and Hospital, Dibrugarh, from August 2018 to July 2021. The study included cadavers of various ages and both genders (N=46). Perinatal cadavers received from the Obstetrics and Gynecology department were also included. The thoracic cavity was opened by cutting through the costochondral junctions and reflecting the sternum. Fibrofatty tissue was removed to expose the branches of the AA, which were then examined and classified. Variations were observed, and the results were expressed in terms of frequency and percentages. Results: A classical branching pattern (Type-A) was observed in 89.1% of cadavers. Five cadavers (10.9%), comprising four males and one female, exhibited branching patterns different from the classical pattern. Among them, Type-C variation was noted in 4 (8.7%) cadavers, and Type-D variation was found in 1 (2.2%) male cadaver. Conclusion: Having a good understanding of the variations in the branching pattern of the arch of the aorta can be beneficial for surgeons performing complex vascular surgery.

Morphology of aortic arch branching patterns in the Eurasian Otter (Lutra lutra, Linnaeus, 1758).

In this study, we investigated the aortic arch (AA) branching pattern in the Eurasian otter (Lutra lutra). We performed arterial silicone casting of the AA of 18 Eurasian otters (8 males and 10 females). We analyzed the AA branching pattern at three levels: the AA, brachiocephalic trunk (BCT), and subclavian artery (SB), using different classification methods at each level. We introduced new criteria for classifying the SB branching pattern applicable for Eurasian otter and other carnivores based on the sequence of the four main branches: vertebral artery (VT), internal thoracic artery (IT), costocervical artery (CCT), and superficial cervical artery (SC). In all Eurasian otters, two major branches emerged directly from the AA, i.e., the BCT and left SB. The BCT branched off the left common carotid artery and terminated in the right common carotid artery and right SB in 17 of 18 Eurasian otters; the BCT formed a bicarotid artery in the remaining case. The SBs showed various branching patterns, with the main branching pattern involving branching to the VT and IT at the same position, followed by the CCT and SC. The SB branching pattern in the Eurasian otter differed from that in dogs in that the two first branching arteries were VT and IT, rather than VT and CCT. Here, we present the anatomical characteristics of the AA branching patterns in the Eurasian otter and new analysis methods applicable for comparative studies of other carnivores.

Anatomical variation in the branching pattern of the aortic arch: a literature review.

Many anatomical variations of the branching pattern of the aortic arch have been documented in the literature. These find their origin in alterations to the embryological development of the arch and have significant implications for surgical and radiological interventions. Embase and Medline database searches were carried out in June 2021 and identified 1197 articles, of which 24 were considered eligible. Twenty-eight variations were found. The prevalence of the six main variations found is as follows: normal configuration (61.2-92.59%); bovine arch type 1 (4.95-31.2%); bovine arch type 2 (0.04-24%); origin of left vertebral artery (0.17-15.3%); aberrant right subclavian artery (0.08-3.33%); thyroid ima artery (0.08-2%). Concomitant variations present in conjunction with these variations are also documented, as were other variations which could not be classified into these six groups. Anatomical variations in the branching pattern of the aortic arch are present in over one-third of individuals in some populations. These are important pre- and intra-operatively during thoracic, neck and thyroid surgery. A greater effort should be employed to construct an official classification to facilitate greater understanding among clinicians.

Neurological Complications of Infective Endocarditis: Beware Of Intracerebral Mycotic Aneurysms, Case Report

The modal branching pattern of the aortic arch in humans consists of three large vessels arising from the aorta, which are: the brachiocephalic arterial trunk, the left common carotid artery, and the left subclavian artery. Birth defects of the supra-aortic vessels are usually asymptomatic and incidental. We report two cases of this variant of the normal.

Common origin of the brachiocephalic arterial trunk and the left common carotid artery: two cases and review of the literature

The modal branching pattern of the aortic arch in humans consists of three large vessels arising from the aorta, which are: the brachiocephalic arterial trunk, the left common carotid artery, and the left subclavian artery. Birth defects of the supra-aortic vessels are usually asymptomatic and incidental. We report two cases of this variant of the normal.

A Cadaveric Study on the Anatomic variation in the formation and variations in the branching pattern of superficial palmar arch and its clinical relevance

A Cadaveric Study on the Anatomic variation in the formation and variations in the branching pattern of superficial palmar arch and its clinical relevance

Aortic Arch Variations and Supra-aortic Arterial Tortuosity in Stroke Patients Undergoing Thrombectomy

PurposeUnfavorable vascular anatomy can impede thrombectomy in patients with acute ischemic stroke. The aim of this study was to determine the prevalence of aortic arch types, aortic arch branching patterns and supra-aortic arterial tortuosity in stroke patients with large vessel occlusion.MethodsComputed tomography (CT) and magnetic resonance (MR) images of all stroke patients in an institutional thrombectomy registry were retrospectively reviewed. Aortic arch types and branching patterns of all patients were determined. In patients with anterior circulation stroke, the prevalence of tortuosity (elongation, kinking or coiling) of the supra-aortic arteries of the affected side was additionally assessed.ResultsA total of 1705 aortic arches were evaluated. Frequency of aortic arch types I, II and III were 777 (45.6%), 585 (34.3%) and 340 (19.9%), respectively. In 1232 cases (72.3%), there was a normal branching pattern of the aortic arch. The brachiocephalic trunk and the left common carotid artery had a common origin in 258 cases (15.1%). In 209 cases (12.3%), the left common carotid artery arose from the brachiocephalic trunk. Of 1598 analyzed brachiocephalic trunks and/or common carotid arteries, 844 (52.8%) had no vessel tortuosity, 592 (37.0%) had elongation, 155 (9.7%) had kinking, and 7 (0.4%) had coiling. Of 1311 analyzed internal carotid arteries, 471 (35.9%) had no vessel tortuosity, 589 (44.9%) had elongation, 150 (11.4%) had kinking, and 101 (7.7%) had coiling.ConclusionWith 20%, type III aortic arches are found in a relevant proportion of stroke patients eligible for mechanical thrombectomy. Nearly half of the stroke patients present with supra-aortic arterial tortuosity, mostly arterial elongation.

Computed Tomographic Analysis of Aortic Arch Branching Patterns: Revisited

Branching pattern of aortic arch (AA) has a direct impact on the outcomes of thoracic surgical and angiographic procedures. Since, geographical variations in the branching pattern of AA have been described, this descriptive cross-sectional study describes the AA variations in a Sri Lankan population compared to the available global data. For that, contrast-enhanced computed tomographic studies (CTC) of thorax (n = 219) performed in males (49.3%) and females (50.7%), aged 59 ± 17 years (range: 4 to 96 years), were evaluated. Branching patterns of AA were categorized into seven types as described by Popieluszko et al. Only, four AA types were identified in the study population: type 1 (90%; n = 197), type 2 (n = 10, 4.6%), type 3 (n = 8, 3.7%), and type 6 AA (n = 4; 1.8%). The prevalence of AA variations was 10%. Type 1 AA was the most prevalent pattern in both genders: female, 91%; males, 88.9%. The most prevalent AA variant in females was type 2 (n = 6; 5.4%); males type 3 (n = 5; 4.6%). However, the branching pattern of AA has not demonstrated a significant gender influence (odds: 0.792; 95% CI: 0.327–1.917; p = 0.605). Variations in branching pattern of AA are as high as 10% among Sri Lankans. Thus, an in-depth knowledge on population specific prevalence of AA variants would influence the modifications of surgical approaches and the choice of angiographic catheters to be utilized, which in turn would minimize inadvertent vascular injuries during thoracic surgical and angiographic interventions.

Variations in the Pattern of the Deep Palmar Arch of the Hand and Its Surgical Importance.

BackgroundThe deep palmar arch is formed by anastomosis of the continuation of the radial artery with the deep palmar branch of the ulnar artery. With recent advances in microsurgical techniques for vascular repair, the knowledge of variations in the arteries of the hand, as well as the caliber of these arteries, has become more important for surgeons. Additionally, radial artery harvesting for myocardial revascularization is being performed nowadays, for which collateral circulation in the hand through the palmar arches is a prerequisite. Therefore, this study was conducted to study the patterns of the deep palmar arch and perform the morphometry of the arch.MethodologyIn this study, 30 hands (16 right and 14 left) from formalin-fixed adult human cadavers were dissected to observe the completeness, formation, and branching pattern of the deep palmar arch. The length of the arch was measured using a thread and scale. The diameters of the forming arteries and branches of the arch were measured at their origin using a digital vernier caliper.ResultsAll deep palmar arches were complete. The arches were classified into two types based on whether the superior or inferior deep palmar branch of the ulnar artery completed the arch. Another classification was based on the interosseous space through which the radial artery or its branch entered the palmar region to complete the deep palmar arch. The length of the arch was 4.2 ± 0.47 cm on the right side and 4.0 ± 0.6 cm on the left side. The diameters of the deep palmar branch of the radial and ulnar arteries at their origin were 4.02 ± 0.48 mm and 1.90 ± 0.36 mm, respectively. No significant difference was found between the right and left sides.ConclusionsThe anastomosis was found between radial and ulnar arteries in all cases of the deep palmar arch. Therefore, it can be safe to sacrifice the radial artery in procedures such as radial artery harvesting and radial artery flap transfer. The knowledge of variations and morphometry of the arch will facilitate vascular repair surgeries on hands.

CT Angiographic Study of Anatomical Variations of Aortic Arch Branches in Libyan Patients

The aim of this study is to determine the prevalence of the aortic arch branches variations in Libyan patients. The proportion of each type will be determined. Subjects and methods: This retrospective study was carried out on 229 cancer patients referred to the CT Scan Department for enhanced chest CT scanning. The scans showed that 83% of the patients had classical aortic arch branching patterns, and 17% had aortic arch variations. Bovine arch variation was the most common variation seen, reaching 11.4%, in which brachiocephalic and left common carotid arteries arise from the aortic arch in a common trunk. The prevalence of the left vertebral artery type that originates from the aortic arch was 3.9%. The prevalence of the aberrant right subclavian artery type was 2.6%, and of the aberrant right subclavian artery with common carotid trunk type was 1.74%. No relationship was found between gender and aortic arch branches variations. We conclude that aortic arch branching variations exist and hence, attention must be paid during chest surgical operations/radiological interventions to ensure safe procedure outcomes. Also, a CT scan is a good method to study such variations and the associated branching patterns.

Branching patterns and anatomical variations of human aortic arch in Indian population

Knowledge of the aortic arch branching pattern is important during supra-aortic angiography, aortic instrumentation, thoracic and neck surgery. The aortic arch (AA) is located in the superior mediastinum. In 65–80% of the cases, the three branches arise from the aortic arch, namely, the brachiocephalic trunk (BCT), the left common carotid artery (LCCA), and the left subclavian artery (LSA). The purpose of this study is to describe different branching patterns of the arch of the aorta in Indian subjects. This observational study is based on dissection performed on Sixty embalmed arches of the aorta in adult Indian cadavers (in manuscript it was written as, 20 dissected heart specimens were collected of still-born fetuses) were exposed and their branches examined during cadaveric dissection in the department of Anatomy. The anatomical variations of the arch of the aorta and its branches, its branches at site of origin, and the distance of each branch from the point of origin to the median plane were measured. The usual three-branched pattern of arch of aorta was found in 44 specimens (73.33%). The common trunk for both brachiocephalic trunk and left common carotid artery was present in 11 specimens (18.33%). In 2 specimens (3.33%), the arch gives four branches. In 1 specimen (1.67%), give three branches. The wide spectrum of variations in the anatomical arrangement of the human aortic arch and its branches offer valuable information to catheterize the aortic arch and its branches for safely performing endovascular surgery. These anatomical and morphologic variations in the arch of the aorta and its branches are significant for diagnostic and surgical procedures in the thorax, head and neck regions.

Anatomical variations of the aortic arch branching pattern using CT angiography: a proposal for a different morphological classification with clinical relevance.

The aortic arch (AA) branching pattern variations are usually asymptomatic, but they may lead to complications during cardiovascular procedures. In this retrospective study, we aimed to analyze the frequency of anatomical variations of the AA and to develop a different approach of morphological classification based on radiological criteria. 1026 computed tomography angiography scans of adults were evaluated and the presence of left-sided (LAA) and right-sided (RAA) AA were determined in 1023 (99.71%) and 3 (0.29%) of patients, respectively. According to the number of branches, LAA branching pattern of each patient was subclassifed in five morphological types. Based on the order and type-specific reference points, an anomalous LAA variants were classified into 20 subtypes. Type 1 (Typical branching pattern) LAA was identifed in 781 (76.12%) of the patients. Among 242 aberrant LAA variants (four types, 23.58%), the most common subtypes; Type 2A with brachiocephalico-carotid trunk (BCT), Type 4A1 with an aberrant left vertebral artery (ALVA), and Type 3A1, in which BCT coexisted with ALVA, were observed in 17.6%, 3.6%, and 0.88% of the cases, respectively. The frequency of remaining LAA variants ranged from 0.39% to 0.097%. In addition, Type 3B2 and Type 4C were first identified in our study. We observed Type I and II RAA in one female (0.097%) and two cases (male and female, 0.19%), respectively. Knowledge of AA branching variations is of great interest in neck and thoracic surgery and the new morphological types in clinically applicable form recommended in this study can be used in endovascular interventions.

Morphometry of the aortic arch and its branches. A computed tomography angiography-based study.

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. 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. 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%). 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.

Investigating the Association between Aortic Arch Variants and Intracranial Aneurysms.

There is an association between anterior cerebral artery vessel asymmetry and anterior communicating artery aneurysm, presumably based on flow dynamics. The purpose of this study is to investigate the potential relationship between aortic arch branching patterns and incidence of intracranial aneurysm. This study included patients scanned over 1 year at our tertiary care center who underwent high-resolution imaging (computed tomography angiography or digital subtracted angiogram) of the head and neck arteries, aortic arch, and superior mediastinum. Exclusion criteria included patients with suboptimal images. Patient age, gender, aortic arch branching pattern, and the presence, location, and number of aneurysms were documented. Among the 1082 patients analyzed, 250 (23%) patients had a variant aortic arch branching pattern, 22 (8.8%) of whom had aneurysms. There were 104 patients with 126 aneurysms, with majority of patients with normal aortic arch branching pattern (n = 82, 79%). The most common variant was a common origin of the left common carotid artery and brachiocephalic trunk with or without direct origin of the left vertebral artery. Twenty-two patients with aneurysms had an aberrant aortic arch (21%), compared to 232 patients without an aneurysm (24%). Fischer exact test showed no statistically significant difference between the incidence of aneurysm with different aortic arch variant groups (two-tailed p-value = 0.715). To our knowledge, this is the first study to examine the association between aortic arch branching patterns and incidence of intracranial aneurysm. No significant association was found between aortic arch branching pattern and the incidence of intracranial aneurysm.