Dumfarth Julia, Chou Alan S, Ziganshin Bulat A, Bhandari Rohan, Peterss Sven, Tranquilli Maryann, Mojibian Hamid, Fang Hai, Rizzo John A, Elefteriades John A
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia.
J Thorac Cardiovasc Surg. 2015 Jun;149(6):1586-92. doi: 10.1016/j.jtcvs.2015.02.019. Epub 2015 Feb 14.
To examine the potential of aortic arch variants, specifically bovine aortic arch, isolated left vertebral artery, and aberrant right subclavian artery, as markers for thoracic aortic disease (TAD).
We screened imaging data of 556 patients undergoing surgery due to TAD for presence of aortic arch variations. Demographic data were collected during chart review and compared with a historical control group of 4617 patients.
Out of 556 patients with TAD, 33.5% (186 patients) demonstrated anomalies of the aortic arch, compared with 18.2% in the control group (P < .001). Three hundred seventy (66.5%) had no anomaly of the aortic arch. Bovine aortic arch emerged as the most common anomalous branch pattern with a prevalence of 24.6% (n = 137). Thirty-five patients (6.3%) had an isolated left vertebral artery, and 10 patients (1.8%) had an aberrant right subclavian artery. When compared with the control group, all 3 arch variations showed significant higher prevalence in patients with TAD (P < .001). Patients with aortic aneurysms and anomalous branch patterns had hypertension less frequently (73.5% vs 81.8%; P = .048), but had a higher rate of bicuspid aortic valve (40.8% vs 30.6%; P = .042) when compared with patients with aneurysms but normal aortic arch anatomy. Patients with aortic branch variations were significantly younger (58.6 ± 13.7 years vs 62.4 ± 12.9 years; P = .002) and needed intervention for the aortic arch more frequently than patients with normal arch anatomy (46% vs 34.6%; P = .023).
Aortic arch variations are significantly more common in patients with TAD than in the general population. Atypical branching variants may warrant consideration as potential anatomic markers for future development of TAD.
研究主动脉弓变异，特别是牛型主动脉弓、孤立性左椎动脉和迷走右锁骨下动脉，作为胸主动脉疾病（TAD）标志物的可能性。
我们筛查了556例因TAD接受手术患者的影像学数据，以确定是否存在主动脉弓变异。在病历审查过程中收集人口统计学数据，并与4617例患者的历史对照组进行比较。
在556例TAD患者中，33.5%（186例）表现出主动脉弓异常，而对照组为18.2%（P <.001）。370例（66.5%）无主动脉弓异常。牛型主动脉弓是最常见的异常分支模式，患病率为24.6%（n = 137）。35例患者（6.3%）有孤立性左椎动脉，10例患者（1.8%）有迷走右锁骨下动脉。与对照组相比，所有3种主动脉弓变异在TAD患者中的患病率均显著更高（P <.001）。与主动脉弓解剖结构正常的动脉瘤患者相比，患有主动脉瘤和异常分支模式的患者高血压发生率较低（73.5%对81.8%；P =.048），但二叶式主动脉瓣发生率较高（40.8%对30.6%；P =.042）。有主动脉分支变异的患者明显更年轻（58.6±13.7岁对62.4±12.9岁；P =.002），且比主动脉弓解剖结构正常的患者更频繁地需要对主动脉弓进行干预（46%对34.6%；P =.023）。
主动脉弓变异在TAD患者中比在普通人群中显著更常见。非典型分支变异可能值得作为TAD未来发展的潜在解剖学标志物加以考虑。
