Anatomic patterns of the supra-aortic vessels from the aortic arch in the era of total endovascular arch repair

AIM To characterize the anatomic pattern of the aortic arch and the supra-aortic trunks (SAT: brachio-cephalic trunk, BCT; left common carotid artery, LCCA; left subclavian artery, LSA) in terms of mutual distances starting from the aortic valve (AV), clockface orientation from the sagittal aortic axis and aortic diameters. METHODS Measurements of Computed Tomography Angiograms (CTAs) in three groups of patients (without any pathology of the aortic arch, group A; with dilatation of the aortic arch, B; with dilatation of the descending thoracic aorta below the LSA, C) were retrospectively collected and analyzed. RESULTS A total of 230 CTAs were analyzed (80 in group A, 71 in B, 79 in C). Significant differences were recorded among the three groups in terms of mutual distances (being AV-BCT and BCT-LCCA significantly lower in patients of group A if compared to both group B and C, both P<.0001) and take-off angles (being BCT the lowest in group A and LCCA the lowest in group C). In group A, all SAT mutual distances showed a positive correlation with increasing aortic diameters. In group B and C, both the distances VAP-BCT and BCT-LCCA showed a positive correlation with increasing aortic diameters (R=0.22 and 0.24 respectively for group B; R=0.46 and 0.38 respectively for group C). In group B, the take-off angles of both LCCA and LSA showed a negative correlation with increasing aortic diameters (R= -0.26 and -0.23 respectively). CONCLUSION The anatomic pattern of the aortic arch and the SAT varied significantly among the three groups.