STUDY ON BRANCHING PATTERN OF ARCH OF AORTA IN SOUTH INDIAN POPULATION

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Int J Anat Res 2014, 2(4):673-76. ISSN 2321-4287 673

Original Article

STUDY ON BRANCHING PATTERN OF ARCH OF AORTA IN SOUTH

INDIAN POPULATION

**Durai Pandian K* , Radha K, Sundaravadhanam K.V.K.**

ABSTRACT

Address for Correspondence: Dr. Radha. K, S-8. St aff Quart ers, Karpaga V inayaga m edical college, Chinnakolambakkam ,Palayanoor Post , M adhurant hagam, Kanchipuram -603308. Tamilnadu. India. E-M ail: ajjuradha@gm ail.com

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Depart m ent of Anat omy, Karpaga Vinayaga Inst it ute of M edical sciences, Kanchipuram , India.

Background and aim:Arch of aort a is t he cont inuat ion of ascending aort a lies in t he superior m ediast inum .The present st udy aim s at finding t he br anching pat t er n of arch of aort a and correlat e it w it h t he em broyological and clinical signif icance.

M aterials and M ethods: 30 form alin-fixed cadavers procured from t he depart m ent of anat omy, Karpaga Vinayaga Inst it ut e of M edical Sciences, M adhurant hagam w er e dissect ed t o st udy t he branching pat t ern of arch of aort a. Results: Out of 30 cadavers 19 cadavers Norm al branching pat t ern (Right brachiocephalic, Left com m on carot id and Lef t subclavian ar t er y).10 cadaver s show ed t he lef t com m on car ot id ar ising in com m on w it h t he brachiocephalic t r unk. Only one show ed t he left vert ebral ar t ery arising direct ly from t he aort a, t he origin lying bet w een left carot id and left subclavian art eries.

Conclusion: Know ledge of norm al anat om y and frequency in t he variat ions in t he branching pat t ern of t he arch of aort a is of great im port ance in pat ient s w ho have t o undergo aort ic inst rum ent at ion, f our vessel angiography or supraaort ic t horacic, head and neck surgery.

KEY W ORDS: Arch of aorta, Brachiocephalic, Vert ebral art ery.

BACKGROUND

Int ernat ional Journal of Ana tomy and Research,

Int J Anat Res 2014, Vol 2(4):673-76. ISSN 2321- 4287 DOI: 10.16965/ ijar.2014.522

Received: 27 Oct 2014

Peer Review : 27 Oct 2014 Published (O):30 Nov 2014 Accept ed: 10 Nov 2014 Published (P):31 Dec 2014

Internat ional Journal of Anat omy and Research ISSN 2321-4287

w w w.ijm hr.org/ ijar.ht m

DOI: 10.16965/ ijar.2014.522

Aort ic of aort a or aort ic arch is t he cont inuat ion of t he ascending aort a in t he superior m ediast i-num . It s origin is slight ly t o t he right and is in level w it h t he upper border of t he second right st er n o co st al j o in t . Th e ar ch f ir st ascend s diagonally back and t o t he left over t he ant erior surface of t he t rachea, t hen back across it s left side and finally descends t o t he left of t he fourt h t horacic vert ebral body and cont inues as t he descending t horacic aorta. It ends level w it h t he st ernal end of t he second left cost al cart ilage [1]. The brachiocephalic t runk, left com m on carotid and left subclavian arteries are t he t hree m ajor branches t hat arise from t he convex

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Int J Anat Res 2014, 2(4):673-76. ISSN 2321-4287 674 M ATERIALS AND M ETHODS

Durai Pandi an K, Radha K, Sundaravadhanam K.V.K. STUDY ON BRANCHING PATTERN OF ARCH OF AORTA IN SOUTH INDIAN POPULATION

in iat rogenic injuries of t he variant branches and t heir com pression by adjacent st ruct ures or problem s in t he cat het erizat ion procedures [4]. Less t han 1% of t he congenit al cardiovascular defect s show s t he incidence of t he congenit al aort ic arch abnorm alit ies [3]. Anom alous origins and t he dist ribut ion of t he large aort ic arch vessels could cause changes in t he cerebral haem odynam ics t hat could lead t o cerebrovas-cul ar accid en t s [ 5] . Kn ow ledge of n or m al anat om y and frequency in t he variat ions in t he branching pat t ern of t he arch of aort a is of great im port ance in pat ient s w ho have t o undergo aort ic inst rum ent at ion, four vessel angiography or supraaort ic t horacic, head and neck surgery.

The present st udy was undertaken t o describe t he branching pat t ern of t he aort ic arch in sout h i n di an su b j ect s an d co r r el at e sam e w i t h em broyological and clinical significance.

The present st udy w as done in t he 30 form alin-fixed cadavers t hat w ere used for t he dissect ion t raining of undergraduat e m edical st udent s of Karpaga Vinayaga Inst it ut e of M edical Sciences, M adhurant hagam . Only m ale cadavers w ere used for the study because of t he non-availability of fem ale cadavers.

Branching pat t ern of t he arch w as not ed as follow s:

Type A - Norm al pattern (Right brachiocephalic, Left com m on carot id and Left subclavian artery).

Type B - The lef t com m on carot id arising in com m on w it h t he brachiocephalic t runk.

Type C- Origin of left vertebral art ery direct ly from t he aort a, t he origin lying bet w een left carot id and left subclavian art eries.

RESULTS

In t he present st udy, t he norm al branching pat t er n w as observed in 19 cases.10 cases show ed t ype-B. In only one case t he vert ebral artery direct ly arose from t he arch of aorta (Type C).

Type of

presentation Percentage Type-A 63.33

Type-B 33.33

Type-C 3.33

Tab. 2: Frequency of dist ribut ion of branching patt ern of aort ic ar ch am ong Indian Populat ion.

Type of

presentation Norm al

Common

trunk

Lt vertebral artery from arch

of aorta

Sunnitha et al[9] 74.28 14.2 11.4

Faizal et al[12] 84 - 16.6

Sum ita Tulsidas

Patel et al[13] 77.3 14.66 8

Rekha et al[14] 92.72 2.72 4.5

Present study 66.33 33.33 3.33

Tab. 3: Frequency of dist ribut ion of branching patt ern of aort ic arch am ong various Populat ions.

M usca aca re t al[ 1 5] (Turkish

pop ulat ion)

74 .46 1 4.9 1 2.13

M an ge et al [ 16 ] Ke nyan pop ulat ion)

67 .3 25 .7

-Ada chi e t a l[ 1 7] (Jap anese pop ulat ion)

83 .3 10 .9 4 .3

Pr ese nt st udy( Sout h

India n pop ulat ion)

63 .33 3 3.3 3 3.33

Type of

pr ese nt at ion No rm a l

Com m on t r unk

Le ft ve rt e bra l

ar ter y f rom ar ch

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Int J Anat Res 2014, 2(4):673-76. ISSN 2321-4287 675

Fig. 2A, 2B: Type B-LCA arising in com m on w it h BCT, AOA-Arch of Aorta, CT-Com m on Trunk, BCA-Brachiocephlic Tr uunk, LCCA-Left Com m on Carot id

Art ery, LSA-Left Subclavian Art ery.

Fig. 3A,3B: Type C- VA arising from AOA, AOA-Arch of Aorta, BCT-Brachiocephalic Trunk, LCCA-Left Com m on Carot id Ar t ery, VA-Vert ebral Art ery, LSA-Left Subclavian

Artery.

DISCUSSION

The great vessels of t he t horacic region are w ell know n for t heir variat ions. The arch of aort a is one of t hem , w it h w ell know n variat ions [6]. These variat ions in origin and course of m ain vessel s occur r i ng eit h er i nd iv idu al ly o r in com binat ion w it h ot her cardiovascular defect s are m ost ly explainable on ont ogenic basis, w hi ch ser ves as b asi s f o r a m ul t i t u d e o f clinically relevant abnorm alit ies [7].The final relat ive disposit ion of t he aort ic arch and it s branches is probably due t o difference in growt h rat es in t he various art eries and t he associat ed “ m igrat ion” and “ m erging” of t he branches [8].

An analysis of variat ion in branches from 1000 aort ic arches show ed t he usual pat t ern in 65%, a l ef t co m m o n car ot i d sh ar ed t h e brachiocephalic t runk in 27% and t he four large ar t er ies br anched sep ar at ely in 2.5%. The remaining 5% show ed a great variety of patterns, t he m ost com m on (1.2%) being sym m et ric right and left brachiocephalic t runks[1].

The classic or norm al pat t ern of branching is t he origin of brachiocephalic art ery, left com m on carot id art er y and lef t subclavian art er y as separat e br anches f rom arch of aort a. This “ norm al” form occurs in approxim at ely 70% of pat ient s .The incidence of t his pattern is know n t o occuring in 48% of w hit e and 84% of black individuals.[9] The present st udy show s it t o be 63.33%.

The Com m on Origin of t he brachiocephalic and left Com m on Carot id Ar t eries is called by a m isnom er “ bovine” arch. This pat t ern of aort ic ar ch i s m o r e com m o n i n b l ack s w i t h t h e occurrence of 25% and is seen in only 8% of w hit es. Over all 13% o f pat ient s sh ow t his pat t ern of branching [9]. The present st udy show s this a pat tern in t he frequency 20% w hich is of higher incidence of norm al populat ion.

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Int J Anat Res 2014, 2(4):673-76. ISSN 2321-4287 676 Conflicts of Interests: None

w hit es [9]. It w as found t o be in t he frequency of 13.33% in t he present st udy w hich w as higher t han t he general populat ion.

In t he present st udy, t here was a direct origin of t he left vert ebral art ery from t he upper surface of t he aort ic arch in only one case and it w as locat ed bet w een origins of t he left com m on carot id and left subclavian art eries. Increased absor pt ion of em br yonic t issue of t he lef t subclavian artery betw een the origin of the aort ic arch and t he vert ebral art ery m ay be t he reason for such direct origin of t he left vert ebral art ery from the aortic arch. If the detection of a vertebral art ery in t he norm al posit ion is not possible, t he presence of such a variant m ust be taken int o considerat ion [10]. Even t hough t he branching pat t erns of t he aort ic arch are considered t o be variants of som e deviations from t he comm onest pat t ern of developm ent , t here w ere not any n ot iceab l e si gns o f an at om i cal p at h ol ogy associat ed w it h t hose variat ions [11].

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Durai Pandian K, Radha K, Sundaravadhanam K.V.K. STUDY ON BRANCHING PATTERN OF ARCH OF AORTA IN SOUTH INDIAN POPULATION. Int J Anat Res 2014;2(4):673-676.