Aortic Root Anomalies of the Neck Presenting in Adults. Review of the Literature with Three Case Reports

Anatomy of the thoracic aorta and of its branches

For a surgeon performing chest operation, thorough knowledge of the anatomy of the thoracic aorta and of its branches are essential not only to ensure the preservation of adequate organ vascular supply during reconstructive surgery of the esophagus or trachea but also to avoid injury to important thoracic vascular structures. This knowledge is of paramount importance especially for surgeons performing operations for mediastinal disorders or tumors to avoid catastrophic complications. This article discusses the anatomy and the most common congenital abnormalities of the thoracic aorta and its branches.

The Surgical Management of Aortic Root Vessel Anomalies Presenting in Adults

Anomalies of the aortic root vessels may present in adults and are common incidental findings during standard vascular imaging. Knowledge of their presentation and management is important for surgeons dealing with vascular pathology within these anomalous vessels. A comprehensive literature search was conducted and a review of the current opinion performed on the embryology, clinical features, and surgical treatment of aortic root vessel anomalies, with particular emphasis on their management in adults. A classification system for aortic arch anomalies based on arch configuration is presented: (1) double aortic arch, (2) right aortic arch, (3) left aortic arch with abnormal branching, and (4) interrupted aortic arch. Anomalies of the aortic root vessels may be classified based on their presence or absence, their anomalous size or course, or their atypical origin, bifurcation, or subsequent branching pattern. A symptomatic aberrant right subclavian artery may be encountered by vascular surgeons, and a right supraclavicular approach would appear the most appropriate method of repair. Knowledge of aortic arch and root vessel anomalies is important for any clinician dealing with cardiothoracic, head and neck, or intracranial pathology. Vascular surgeons may encounter these anomalies during routine practice and may need to deal with their clinical sequelae.

Aortic Arch Anomalies are Associated with Increased Risk of Neurological Events in Carotid Stent Procedures

OBJECTIVE

To establish the risk of carotid artery stent (CAS) complications in patients with aortic arch anomalies.

METHODS

In a prospective series of patients submitted to CAS, all cases with arch anomalies were compared with cases with normal arch anatomy (type I, II and III) in order to assess the impact of anatomic characteristics on technical and clinical outcome. Outcome was evaluated in term of neurological complications and technical success.

RESULTS

Of 214 consecutive patients undergoing CAS, 189 (88.3%) had normal arch anatomy and 25 (11.7%) arch anomalies. The arch abnormalities included common origin of brachiocephalic trunk and left common carotid artery in 22 cases (10.2%), separate origin of right subclavian and common carotid in 2 cases (0.9%) and left common carotid agenesis with separate arch origin of internal and external carotid in 1 case (0.5%). The two groups were not different in term of epidemiology and preoperative clinical and morphological characteristics. Technical failure occurred overall in 26 cases (12%) and neurological complication in 14 cases (6.5%). All symptoms were temporary. Technical failure was higher in the arch anomaly group; however the difference did not reach statistical significance (89.6% vs 76.4%, P=0.1). Neurological complications occurred more frequently in the arch anomaly group (20% vs 5.3%, P=0.039). Type of arch was the only variable independently associated with neurological complications (OR=2.01, p=0.026).

CONCLUSION

Aortic arch anomalies are not infrequent and are associated with increased risk of neurological complications. The indication for CAS should be carefully evaluated in these cases.