Variant anatomy of the aortic arch

Last revised by Dr Abanindu Thakur on 19 Sep 2021

Variant anatomy of the aortic arch occurs when there is failure of normal aortic development. It results in a number of heterogenous anomalies of the aorta and its branch vessels.

Gross anatomy

Normally, the aorta ascends in the superior mediastinum to the level of the sternal notch before arching posteriorly and descending in the left hemithorax. The arch gives off three branch vessels, the brachiocephalic (also called the innominate), left common carotid and left subclavian arteries.

Aortic development is a complex process that takes place during the third week of gestation. During development, the two dorsal aortae fuse to form the descending aorta, the ventral aortic limbs fuse to form the aortic sac, the left 4th arch vessel becomes the aortic arch and the right 4th arch vessel becomes atretic distally.

Variant anatomy

Common arch anomalies

When there is departure from normal development, variant anatomy occurs. Commonly, failure of normal regression of the 4th arch vessels results in a double aortic arch or right-sided aortic arch.

Other arch anomalies
Branch vessel anomalies

Abnormal formation of the 1st, 2nd and 3rd arch vessels results in abnormal branch vessels:

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Cases and figures

  • Figure 1: development of aortic arch (diagram)
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  • Case 1: bovine arch
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  • Case 2: bovine arch
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  • Case 3: right sided aortic arch
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  • Case 4: right aortic arch with aberrant left subclavian artery
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  • Case 5: double aortic arch : aneurysmal
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  • Case 6: double aortic arch
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  • Case 8
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  • Case 9: right aortic arch with aberrant left clavian
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  • Case 10: right sided aortic arch
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  • Case 11: double aortic arch
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  •  Case 12
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  • Case 13: bovine arch
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  • Case 14: common origin RSA, RCCA and LSA
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  • Case 16: bovine arch (CTA)
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  • Case 17: variant bronchial artery from the aortic arch
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  • Case 18: aberrant origin of left vertebral artery
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