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A systematic classification of the left-sided aortic arch variants based on cadaveric studies' prevalence

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Abstract

Introduction

Typical branching pattern of the left-sided aortic arch consists of the brachiocephalic trunk (BCT), the left common carotid artery (LCCA) and the left subclavian artery (LSA). Variant patterns have been associated with a broad spectrum of pathologies. The meticulous knowledge of potential aortic arch variants is of utmost importance to radiologists, interventional cardiologists, vascular and thoracic surgeons. The current systematic review collects all aortic arch branching patterns and their frequency as published by various cadaveric studies, calculates prevalence taking into account the gender and the different people background, as well. All extracted variant patterns are classified into types and subtypes according to the number of emerging (major and minor) branches (1, 2, 3, 4 and 5) and to the prevalence they appear. In cases of similar prevalence, total cases were taken into consideration; otherwise the variants were classified under the title “other rare variants”.

Methods

A systematic online search of PubMed and Google books databases was performed only in cadaveric studies.

Results

Twenty studies with typical (78% prevalence) and variable (22%) branching patterns were included. Types 3b, 2b, 4b, 1b and 5b had a prevalence of 81%, of 13%, of 5%, 0% and of 0%, respectively. Common variants were the brachiocephalico-carotid trunk (BCCT, 49% prevalence), the aberrant left vertebral artery (LVA, 41%) and the aberrant right subclavian artery (ARSA, 8%). LVA of aortic origin was detected in 32%, the bicarotid trunk (biCT) in 5% and the bi-BCT trunk in 3%. Thyroidea ima artery, a minor branch emerging from the aortic arch was found in 2%. Coexisted variants were detected in 4% (ARSA with a distinct RCCA and LCCA origin), in 3% (BCCT with a LVA of aortic origin), in 2% (ARSA with a biCT and a vertebrosubclavian trunk).

Conclusion

No significant gender or ethnic differences exist among the 5 branching types. The proposed classification scheme aims to become a valuable and easy to use tool in the hands of all physicians involved in diagnosis and treatment of aortic arch pathology. It could be also useful in anatomical education, as well.

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Abbreviations

LSAA:

Left sided aortic arch

CT:

Common trunk

LVA:

Left vertebral artery

BiCT:

Bicarotid trunk

ARSA:

Aberrant right subclavian artery

LCoA:

Left coronary artery

LSCA:

Left suprascapular artery

BCT:

Brachiocephalic trunk

LCCA:

Left common carotid artery

RCCA:

Right common carotid artery

LSA:

Left subclavian artery

RSA:

Right subclavian artery

RVA:

Right vertebral artery

BiCT:

Bicarotid trunk

BCCT:

Brachiocephalico-carotid trunk

IMA:

Thyroidea ima artery

bi-BCT:

bibrachiocephalic(or bi-anonymous)

b:

Branch

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Acknowledgements

The authors wish to thank Valerie Lentz MS and Wes Price MS, CMI medical illustrators for the illustrations used in this publication and Miss Maria Tzika (MD, MSc) for her valuable assistance with the data meta-analysis.

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Authors and Affiliations

  1. Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece

    K. Natsis, N. Lazaridis & N. Anastasopoulos

  2. Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    M. Piagkou

  3. Hellenic Center for Neurosurgical Research “Petros Kokkalis”, Athens, Greece

    T. Kalamatianos

  4. Medical School, European University of Cyprus, 6, Diogenous Str, 2404, Nicosia, Cyprus

    D. Chytas

  5. Department of Surgery, Konstantopouleio General Hospital, Nea Ionia, 14233, Athens, Greece

    D. Manatakis

  6. Department of Anatomical Sciences, School of Medicine, St George’s University, Saint George’s, Grenada

    M. Loukas

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  1. K. Natsis
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Contributions

KN made the project, edited the paper, and planned schematic representations; MP searched the literature, selected data and wrote the paper, NL searched the literature, selected and extracted the data and edited the paper, TK, DC and DM edited the paper, NA edited the paper and searched the data literature, ML edited the paper and helped with the schematic drawings. All authors approved the final draft.

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Correspondence to K. Natsis.

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Natsis, K., Piagkou, M., Lazaridis, N. et al. A systematic classification of the left-sided aortic arch variants based on cadaveric studies' prevalence. Surg Radiol Anat 43, 327–345 (2021). https://doi.org/10.1007/s00276-020-02625-1

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  • DOI: https://doi.org/10.1007/s00276-020-02625-1

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