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Variant Branching Pattern of the Arch of Aorta: A Study with Embryological and Clinical Implications

Mamatha H, Sushma RK, Antony Sylvan D‟ Souza, and Ajith Kumar

Increasing activity in the fields of cardiac and vascular surgery has revived interest in the developmental and adult anatomy of the aortic arches and the great vessels derived therefrom. The arch of aorta is a continuation of the ascending aorta, located in the superior mediastinum. Three branches, the brachiocephalic trunk, left common carotid artery and left subclavian artery usually arise from the arch of aorta. The brachiocephalic trunk later divides into right common carotid and right subclavian artery. A study was therefore conducted in the Department of Anatomy, Kasturba Medical College, Manipal to study the branching pattern of the arch of aorta. 40 cadavers of both sexes (aged 35-65 years) were included in the study.The thoracic cavity was exposed, lungs were removed, superior vena cava and brachiocephalic veins cleared and pericardium were uncovered to expose the ascending aorta. Fibrofatty tissue and nerves were removed to clarify the branches of the arch of aorta. The arteries were painted and allowed to dry and then photographed. The variant patterns were tabulated. In the present study 85% of the cases showed normal branching pattern, and variations was found in 15% of the cases. The arterial pattern was congregated into four categories based on the frequencies of variations. Prior identification of these vascular anomalies through diagnostic interventions is crucial in order to avoid complications during heart and vascular surgeries.