Research Article
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Arcus aorta dallanma varyasyonlarının bilgisayarlı tomografi anjiyografiler ile değerlendirilmesi

Year 2026, Volume: 79 Issue: 1, 32 - 39, 27.03.2026
https://doi.org/10.65092/autfm.1821303
https://izlik.org/JA42UW36NK

Abstract

Amaç Tipik olarak, arcus aorta proksimalden distale doğru üç dal verir: truncus brachiocephalicus, arteria carotis communis sinistra ve arteria subclavia sinistra. Bu çalışmanın amacı, geniş bir örneklemde arcus aorta (AA) dallanma varyasyonlarının yaygınlığını belirlemek ve cinsiyet farklılıklarını değerlendirmektir.
Gereç ve Yöntemler: Bu çalışma retrospektif, gözlemsel bir radyolojik anatomi çalışması olarak yürütülmüştür. Dallanma varyasyonları şu şekilde kategorize edilmiştir: Tip 1: Normal konfigürasyon (standart dallanmalı sol taraflı arcus aorta), Tip 2: Bovine ark, Tip 3: arteria vertebralis sinistra varyasyonu, Tip 4: arteria vertebralis sinistra ve Bovine ark, Tip 5: Sağ ve sol ortak carotis communis kökü, Tip 6: Aberan arteria subclavia dextra ve Tip 7: Sağ taraflı arcus aorta varyasyonları. Bulgular: Çalışmaya toplam 744 hasta (334 kadın, %44,9 / 410 erkek, %55,1) dahil edildi. Çalışma örnekleminde AA en sık Tip 1 dallanma tipinde görüldü. Tip 1 yaygınlık oranları kadınlarda %98,2, erkeklerde %98,3 ve genel popülasyonda %98,3 olarak bulundu. Çalışmada karşılaşılan diğer dallanma varyasyonları Tip 2, Tip 3, Tip 6 ve Tip 7 idi. Bu varyasyonların yaygınlığı sırasıyla %1,1, %0,3, %0,3 ve %0,1 olarak bulundu. Dallanma varyasyonlarının yaygınlığı açısından cinsiyetler arasında istatistiksel olarak anlamlı bir fark yoktu (p>0,05).
Sonuçlar: Bu çalışma, AA varyantlarının çalışma örnekleminde nadiren bulunduğu sonucuna varmıştır. Her ne kadar sıklıkla asemptomatik ve tesadüfen karşılaşılsalar da, popülasyon yaygınlık farklılıklarının bilinmesinin klinik ve radyolojik değerlendirmelere katkıda bulunacağına inanıyoruz.

Ethical Statement

Çalışmaya başlamadan önce kurumumuz Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu'ndan onay alınmıştır (Karar No:2022-5/29)

References

  • Saddler T. Langman’s Medical Embryology. 6th ed. Baltimore: Williams and Wilkins; 1990. p. 208, 209.
  • Popieluszko P, Henry BM, Sanna B, Hsieh WC, Saganiak K, Pekala PA et al. A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vasc Surg. 2018; 68(1):298–306. https:// doi.org/10.1016/j.jvs.2017.06.097
  • Syperek A, Angermaier A, Kromrey ML, Hosten N, Kirsch M. The so-called “bovine aortic arch”: a possible biomarker for embolic strokes? Neuroradiology. 2019; 61(10):1165–1172. https://doi.org/10.1007/s00234-019-02264-3
  • Lazaridis N, Piagkou M, Loukas M, Piperaki ET, Totlis T, Noussios G et al. A systematic classification of the vertebral artery variable origin: clinical and surgical implications. Surg Radiol Anat. 2018; 40(7):779–797. https:// doi.org/10.1007/s00276-018-1987-3
  • Lu J, Ebraheim NA. The vertebral artery: surgical anatomy. Orthopedics. 1999; 22:1081–1085
  • Shalhub S, Schafer M, Hatsukami TS, Sweet MP, Reynolds JJ, Bolster FA et al. Association of variant arch anatomy with type B aortic dissection and hemodynamic mechanisms. J Vasc Surg. 2018; 68(6):1640–1648. https://doi.org/10. 1016/j.jvs.2018.03.409
  • Ergun E, Şimşek B, Koşar PN et al. Anatomical variations in branching pattern of arcus aorta: 64-slice CTA appearance. Surg Radiol Anat. 2013; 35, 503–509. https://doi.org/10.1007/s00276-012-1063-3
  • Açar G, Çiçekcibaşı AE, Uysal E et al. Anatomical variations of the aortic arch branching pattern using CT angiography: a proposal for a different morphological classification with clinical relevance. Anat Sci Int. 2022; 97: 65–78. https://doi.org/10.1007/s12565-021-00627-6
  • Nelson ML, Sparks CD. Unusual aortic arch variations: distal origin of common carotid arteries. Clin Anat. 2001; 14:62–65. https://doi.org/10 .1002/1098-2353(200101)14:1<62::AID-CA1012>3.0.CO;2-%23 , Nizankowski C, Rajchel Z, Ziolkowksi M. Abnormal origin of arteries from the aortic arch in man. Folia Morphol (Warsz). 1975; 34:109–116.
  • Karkoulias KP, Efremidis GK, Tsiamita MS, Trakada GP, Prodromakis EN, Nousi ED, Spiropoulos KB. Abnormal origin of the left common carotid artery by innominate artery: a case of enlargement mediastinum. Monaldi Arch Chest Dis. 2003; 59:222–223
  • Dumfarth J, Chou AS, Ziganshin BA, Bhandari R, Peterss S, Tranquilli M, et al. Atypical aortic arch branching variants: a novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg. 2015; 149:1586-92. https:// doi.org/10.1016/j.jtcvs.2015.02.019
  • Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat. 2009; 31:319-23. https://doi.org/10.1007/s00276-008-0442-2
  • Shimizu T, Mori T, Yoshioka K, Tanno Y. Thoraco-cervical computed tomographic angiography to determine an appropriate access route for mechanical thrombectomy. J Neuroendovasc Ther. 2021; 15(12), 772-777. https://doi.org/10.5797/jnet.oa.2020-0117
  • Eisenberg R, Vines F, Taylor S. Bifid origin of the left vertebral artery. Radiology. 1986; 159:429–430. https://doi.org/10.1148/radiology. 159.2.3961176
  • Goray BV, Joshi RA, Garg A, Merchanta S, Yadava B, Maheshwariaet M. Aortic arch variation: a unique case with anomalous origin of both vertebral arteries as additional branches of the aortic arch distal to left subclavian artery. AJNR. 2005; 26:93–95.
  • Celikyay ZR, Koner AE, Celikyay F, Denız C, Acu B, Firat MM. Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data. Clin Imaging. 2013; 37:1011-9. https://doi.org/10.1016/j.clinimag.2013.07.008
  • ,Feugier P, Lemoine L, Gruner L, Bertin-Maghit M, Rousselet B, Chevalier JM, et al. Arterioesophageal fistula: a rare complication of retroesophageal subclavian arteries. Ann Vasc Surg. 2003; 17:302-5. https://doi. org/10.1007/s10016-001-0406-z
  • McDonald JJ, Anson BJ. Variations in the origin of arteries derived from the aortic arch, in American whites and negroes. Am J Phys Anthropol. 1940; 27:91–107.

Evaluation of Aortic Arch Branching Variations with Computed Tomography Angiographies

Year 2026, Volume: 79 Issue: 1, 32 - 39, 27.03.2026
https://doi.org/10.65092/autfm.1821303
https://izlik.org/JA42UW36NK

Abstract

Objectives: Typically, aortic arch gives off three branches from proximal to distal: the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery. This study aimed to determine the prevalence of aortic arch (AA) branching variations in a large sample and to assess gender differences.
Materials and Methods: This study was conducted as a retrospective, observational radiologic-anatomy. The branching configurations were categorized as follows: Type 1: Normal configuration (left-sided aortic arch with standard branching), Type 2: Bovine arch, Type 3: Left vertebral artery variation, Type 4: Bovine arch with left vertebral artery variation, Type 5: Common origin of the right and left common carotid arteries, Type 6: Aberrant right subclavian artery, and Type 7: Right-sided aortic arch variations.
Results: A total of 744 patients (334 females, 44.9% / 410 males, 55.1%) were included in the study. In the study sample, AA was most prevalent in Type 1 branching. Type 1 prevalence rates were 98.2%, 98.3%, and 98.3% in females, males, and the overall population, respectively. Other branching variations encountered in the study were Type 2, Type 3, Type 6, and Type 7. The prevalence of these variations was 1.1%, 0.3%, 0.3%, and 0.1%, respectively. There was no statistically significant difference in the prevalence of branching variations between genders (p>0.05).
Conclusions: This study concluded that AA variants were rarely found in the study sample. Although they are often encountered asymptomatically and incidentally, we believe that knowledge of population prevalence differences will contribute to clinical and radiological assessments.

Ethical Statement

Prior to initiating the study, approval was obtained from our institution's Non-Interventional Clinical Research Ethics Committee (Decision No: 2022-5/29).

References

  • Saddler T. Langman’s Medical Embryology. 6th ed. Baltimore: Williams and Wilkins; 1990. p. 208, 209.
  • Popieluszko P, Henry BM, Sanna B, Hsieh WC, Saganiak K, Pekala PA et al. A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vasc Surg. 2018; 68(1):298–306. https:// doi.org/10.1016/j.jvs.2017.06.097
  • Syperek A, Angermaier A, Kromrey ML, Hosten N, Kirsch M. The so-called “bovine aortic arch”: a possible biomarker for embolic strokes? Neuroradiology. 2019; 61(10):1165–1172. https://doi.org/10.1007/s00234-019-02264-3
  • Lazaridis N, Piagkou M, Loukas M, Piperaki ET, Totlis T, Noussios G et al. A systematic classification of the vertebral artery variable origin: clinical and surgical implications. Surg Radiol Anat. 2018; 40(7):779–797. https:// doi.org/10.1007/s00276-018-1987-3
  • Lu J, Ebraheim NA. The vertebral artery: surgical anatomy. Orthopedics. 1999; 22:1081–1085
  • Shalhub S, Schafer M, Hatsukami TS, Sweet MP, Reynolds JJ, Bolster FA et al. Association of variant arch anatomy with type B aortic dissection and hemodynamic mechanisms. J Vasc Surg. 2018; 68(6):1640–1648. https://doi.org/10. 1016/j.jvs.2018.03.409
  • Ergun E, Şimşek B, Koşar PN et al. Anatomical variations in branching pattern of arcus aorta: 64-slice CTA appearance. Surg Radiol Anat. 2013; 35, 503–509. https://doi.org/10.1007/s00276-012-1063-3
  • Açar G, Çiçekcibaşı AE, Uysal E et al. Anatomical variations of the aortic arch branching pattern using CT angiography: a proposal for a different morphological classification with clinical relevance. Anat Sci Int. 2022; 97: 65–78. https://doi.org/10.1007/s12565-021-00627-6
  • Nelson ML, Sparks CD. Unusual aortic arch variations: distal origin of common carotid arteries. Clin Anat. 2001; 14:62–65. https://doi.org/10 .1002/1098-2353(200101)14:1<62::AID-CA1012>3.0.CO;2-%23 , Nizankowski C, Rajchel Z, Ziolkowksi M. Abnormal origin of arteries from the aortic arch in man. Folia Morphol (Warsz). 1975; 34:109–116.
  • Karkoulias KP, Efremidis GK, Tsiamita MS, Trakada GP, Prodromakis EN, Nousi ED, Spiropoulos KB. Abnormal origin of the left common carotid artery by innominate artery: a case of enlargement mediastinum. Monaldi Arch Chest Dis. 2003; 59:222–223
  • Dumfarth J, Chou AS, Ziganshin BA, Bhandari R, Peterss S, Tranquilli M, et al. Atypical aortic arch branching variants: a novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg. 2015; 149:1586-92. https:// doi.org/10.1016/j.jtcvs.2015.02.019
  • Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat. 2009; 31:319-23. https://doi.org/10.1007/s00276-008-0442-2
  • Shimizu T, Mori T, Yoshioka K, Tanno Y. Thoraco-cervical computed tomographic angiography to determine an appropriate access route for mechanical thrombectomy. J Neuroendovasc Ther. 2021; 15(12), 772-777. https://doi.org/10.5797/jnet.oa.2020-0117
  • Eisenberg R, Vines F, Taylor S. Bifid origin of the left vertebral artery. Radiology. 1986; 159:429–430. https://doi.org/10.1148/radiology. 159.2.3961176
  • Goray BV, Joshi RA, Garg A, Merchanta S, Yadava B, Maheshwariaet M. Aortic arch variation: a unique case with anomalous origin of both vertebral arteries as additional branches of the aortic arch distal to left subclavian artery. AJNR. 2005; 26:93–95.
  • Celikyay ZR, Koner AE, Celikyay F, Denız C, Acu B, Firat MM. Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data. Clin Imaging. 2013; 37:1011-9. https://doi.org/10.1016/j.clinimag.2013.07.008
  • ,Feugier P, Lemoine L, Gruner L, Bertin-Maghit M, Rousselet B, Chevalier JM, et al. Arterioesophageal fistula: a rare complication of retroesophageal subclavian arteries. Ann Vasc Surg. 2003; 17:302-5. https://doi. org/10.1007/s10016-001-0406-z
  • McDonald JJ, Anson BJ. Variations in the origin of arteries derived from the aortic arch, in American whites and negroes. Am J Phys Anthropol. 1940; 27:91–107.
There are 18 citations in total.

Details

Primary Language English
Subjects Radiology and Organ Imaging, Anatomy
Journal Section Research Article
Authors

Kaan Çimen 0000-0001-9781-7815

Nisa Başpinar 0000-0003-4240-6001

Submission Date November 10, 2025
Acceptance Date January 27, 2026
Publication Date March 27, 2026
DOI https://doi.org/10.65092/autfm.1821303
IZ https://izlik.org/JA42UW36NK
Published in Issue Year 2026 Volume: 79 Issue: 1

Cite

APA Çimen, K., & Başpinar, N. (2026). Evaluation of Aortic Arch Branching Variations with Computed Tomography Angiographies. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 79(1), 32-39. https://doi.org/10.65092/autfm.1821303
AMA 1.Çimen K, Başpinar N. Evaluation of Aortic Arch Branching Variations with Computed Tomography Angiographies. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2026;79(1):32-39. doi:10.65092/autfm.1821303
Chicago Çimen, Kaan, and Nisa Başpinar. 2026. “Evaluation of Aortic Arch Branching Variations With Computed Tomography Angiographies”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 79 (1): 32-39. https://doi.org/10.65092/autfm.1821303.
EndNote Çimen K, Başpinar N (March 1, 2026) Evaluation of Aortic Arch Branching Variations with Computed Tomography Angiographies. Ankara Üniversitesi Tıp Fakültesi Mecmuası 79 1 32–39.
IEEE [1]K. Çimen and N. Başpinar, “Evaluation of Aortic Arch Branching Variations with Computed Tomography Angiographies”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 79, no. 1, pp. 32–39, Mar. 2026, doi: 10.65092/autfm.1821303.
ISNAD Çimen, Kaan - Başpinar, Nisa. “Evaluation of Aortic Arch Branching Variations With Computed Tomography Angiographies”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 79/1 (March 1, 2026): 32-39. https://doi.org/10.65092/autfm.1821303.
JAMA 1.Çimen K, Başpinar N. Evaluation of Aortic Arch Branching Variations with Computed Tomography Angiographies. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2026;79:32–39.
MLA Çimen, Kaan, and Nisa Başpinar. “Evaluation of Aortic Arch Branching Variations With Computed Tomography Angiographies”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 79, no. 1, Mar. 2026, pp. 32-39, doi:10.65092/autfm.1821303.
Vancouver 1.Kaan Çimen, Nisa Başpinar. Evaluation of Aortic Arch Branching Variations with Computed Tomography Angiographies. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2026 Mar. 1;79(1):32-9. doi:10.65092/autfm.1821303