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Four subtypes with 5 branches. ARSA aberrant right subclavian artery, LCA left common carotid artery, LExCA left external carotid artery, LInCA left internal carotid artery, LSA left subclavian artery, LVA left vertebral artery, RCA right common carotid artery, and RSA right subclavian artery
Source publication
Purpose
To estimate the prevalence of the left-sided aortic arch (LSAA) variants, and the effect of possible moderators on variants’ detection.
Methods
A systematic online literature search was conducted. The pooled prevalence with 95% confidence intervals was estimated for the typical and atypical branching patterns to compare the overall proport...
Citations
... The left and right vertebral arteries (LVA and RVA) emanate from the LSA and RSA. The AA anatomy has been extensively studied due to its high clinical implications [1][2][3][4]. Popieluszko et al. [1] first performed a systematic review with a meta-analysis of the most frequent AA variants, and Natsis et al. [2] and Tsiouris et al. [3] reviewed the left-sided aortic arch (LAA) variants in cadaveric and imaging studies, respectively. The difference between these reviews and Popieluszko et al. [1] was that these researchers investigated, except for the most frequent variations [1], even rarer forms of AA morphology [2,3]. ...
... The AA anatomy has been extensively studied due to its high clinical implications [1][2][3][4]. Popieluszko et al. [1] first performed a systematic review with a meta-analysis of the most frequent AA variants, and Natsis et al. [2] and Tsiouris et al. [3] reviewed the left-sided aortic arch (LAA) variants in cadaveric and imaging studies, respectively. The difference between these reviews and Popieluszko et al. [1] was that these researchers investigated, except for the most frequent variations [1], even rarer forms of AA morphology [2,3]. ...
... Popieluszko et al. [1] first performed a systematic review with a meta-analysis of the most frequent AA variants, and Natsis et al. [2] and Tsiouris et al. [3] reviewed the left-sided aortic arch (LAA) variants in cadaveric and imaging studies, respectively. The difference between these reviews and Popieluszko et al. [1] was that these researchers investigated, except for the most frequent variations [1], even rarer forms of AA morphology [2,3]. Identifying the AA branching pattern is essential to avoid surgical or endovascular complications [1,3]. ...
Background/Objectives: The right-sided aortic arch (RAA) is an uncommon variation of the aortic arch (AA), characterized by the aorta crossing over the right main bronchus. In the RAA, the descending aorta can be found on either the right or left side of the spine. The current study comprises a comprehensive retrospective computed tomography angiography (CTA) investigation into the prevalence of the RAA within the Greek population. Additionally, we will conduct a systematic review and meta-analysis to elucidate both common and rare morphological variants of the RAA. This research is significant as it sheds light on the prevalence and characteristics of the RAA in a specific population, providing valuable insights for clinical practice. Methods: Two hundred CTAs were meticulously investigated for the presence of a RAA. In addition, the PubMed, Google Scholar, and Scopus online databases were thoroughly searched for studies referring to the AA morphology. The R programming language and RStudio were used for the pooled prevalence meta-analysis, while several subgroup analyses were conducted. Results: Original study: A unique case of 200 CTAs (0.5%) was identified with an uncommon morphology. The following branches emanated from the RAA under the sequence: the right subclavian artery (RSA), the right common carotid artery (RCCA), the left common carotid artery (LCCA), and the left vertebral artery (LVA) in common origin with the aberrant left subclavian artery (ALSA). The ALSA originated from a diverticulum (of Kommerell) and followed a retroesophageal course. Systematic Review and Meta-Analysis: Sixty-two studies (72,187 total cases) met the inclusion criteria. The pooled prevalence of the RAA with a mirror-image morphology was estimated at 0.07%, and the RAA with an ALSA was estimated at <0.01%. Conclusions: AA anomalies, specifically the RAA, raise clinical interest due to their coexistence with developmental heart anomalies and possible interventional complications. Congenital heart anomalies, such as the Tetralogy of Fallot and patent foramen ovale, coexisted with RAA mirror-image morphology.
... Isolated left vertebral artery (ILVA) directly originates from the aortic arch, usually between the left common carotid artery and left subclavian artery (LSA) (3). It is the second most common anatomical variant in the variation of the superior aortic trunk, with an incidence of 0.79%-8% (3)(4)(5)(6)(7). TAD with unfavorable PLZ and ILVA is rare. ...
... ILVA has been increasingly recognized as the second most common aortic arch branch variation, with an incidence of 0.79%-8% in general population (3)(4)(5)(6)(7). In patients with TBAD, the frequency of this anomaly is 3.6%, suggesting that ILVA may be related to the occurrence of TBAD (13). ...
Objective
The main purpose of this study was to evaluate the safety and efficacy of Castor single-branched stent-graft combined with fenestrated technique in treatment of thoracic aortic disease (TAD) with unfavorable proximal landing area (PLZ) and isolated left vertebral artery (ILVA).
Methods
From January 2018 to March 2022, 8 patients with TAD (6 patients with type B aortic dissections, 1 patient with type B intramural hematomas, and 1 patient with thoracic aortic aneurysm) underwent thoracic endovascular aortic repair with fenestrated Castor stent-graft due to the existence of ILVA and unfavorable PLZ. Demographic characteristics, surgical details, postoperative complications, follow-up and postoperative CTA imaging results were collected and analyzed.
Results
The primary technical success rate was 100%. The mean operation time was 115 min (range, 70–180 min). All the left subclavian arteries (LSAs) and ILVAs of the eight patients were revascularized by fenestrated Castor stent-grafts. During the follow-up period, no deaths and complications were observed. No internal leakage, aortic rupture, retrograde type A dissection were found on computed tomography angiography. All of the LSAs and ILVAs maintained patency without stenosis.
Conclusion
Castor single-branched stent-graft implantation combined with fenestration technique may be safe and feasible for TAD patients with ILVA and unfavorable PLZ.
... The 2 nd and 3 rd branches are the left common carotid artery (LCCA) and the left subclavian artery (LSA). AA variant branching patterns (23% prevalence) have been associated with dysphagia, vascular diseases, and aortic dissection (1). The increase in cardiovascular interventions requires a deep and detailed understanding of AA anatomy (2). ...
... The increase in cardiovascular interventions requires a deep and detailed understanding of AA anatomy (2). The importance of the evolution of computed tomography (CT) scans in AA variant detection was highlighted in a recent meta-analysis (1). Among the atypical AA variants, the brachiocephalico-carotid trunk (BCCT), is the most common variant (36% prevalence) (1) and is composed of the fused vessels BCT and LCCA. ...
... The importance of the evolution of computed tomography (CT) scans in AA variant detection was highlighted in a recent meta-analysis (1). Among the atypical AA variants, the brachiocephalico-carotid trunk (BCCT), is the most common variant (36% prevalence) (1) and is composed of the fused vessels BCT and LCCA. This arterial complex in humans was falsely characterized as "bovine AA". ...
p> Objective . The current report describes two rare cadaveric findings of a left sided brachiocephalic trunk (BCT) in relation to the trachea, and its high-riding course above the suprasternal notch (SN).
Cases Descriptions . In two elderly body donors dissected after death, a left-sided BCT was identified with a high-riding course (0.5 and 0.8 cm above the SN). The BCT originated from the aortic arch, in common with the left common carotid artery, more distally than the typical left-side location and crossed in front of the trachea. In the 1st case, the ascending and descending aortae, and the left subclavian artery had aneurysmal dilatation. In both cases, the trachea was displaced to the right side and had a stenosis due to the chronic compression.
Conclusion . A high-riding BCT is of paramount clinical importance, as it may complicate tracheotomy, thyroid surgery and mediastinoscopy, leading to fatal complications. BCT injury leads to a massive bleeding during neck dissection (level VI), when the vessel crosses the anterior tracheal wall.</p
... We read with interest a recent article entitled "The left-sided aortic arch variants: prevalence meta-analysis of imaging studies" by Tsiouris et al. [1] which has recently been published in Surgical and Radiologic Anatomy. ...
Introduction
The aberrant right subclavian artery (ARSA), also called as lusorian artery (LA) is a developmental anomaly that exists in conjunction with a right non-recurrent laryngeal nerve (NRLN) in almost all cases. The average prevalence of such a vascular variation is estimated as 1%, although, studies have reported very different population means. Up to date, there is no available data on the frequency of this pattern in the Hungarian population. It can be treated as an indirect marker of a NRLN. Any preoperative information on the course of the inferior laryngeal nerves can help surgeons reduce the risk of an iatrogenic injury during thyroidectomies, especially in an environment where access to intraoperative neuromonitoring is limited.
Objectives
The primary aims were to determine the prevalence of an ARSA, predict the existence of an NRLN in the Hungarian population, and provide demographic analysis.
Methods
A retrospective, computed tomography-based study was carried out. Demographic description and statistical analysis were provided where applicable. Detected anomalous vasculatures were visualized with 3D segmentation, and images were interpreted.
Results
The imaging database review identified three patients with ARSA out of 686 eligible recordings, resulting in a frequency of 0.437% in the study population. All three patients were female and had a retroesophageal LA. Two of them had a Kommerell's diverticulum. One patient had common carotid arteries with a single origin.
Conclusions
The frequency of an ARSA and a concomitant NRLN among Hungarians fits into the results of recent meta-analyses. Preoperative assessment of this anomaly may reduce vocal cord complication rates of thyroidectomies.
