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Aortic Arch Anatomy in Patients with Carotid and Aortic Disease
M. Ashraf Mansour, M.D.1, Amanda McClure, M.D.1, Lindsey Korepta, B.S.2, Shonda Banegas, D.O.1, Robert F. Cuff, M.D.1, Christopher M. Chambers, M.D., Ph.D.1.
1Spectrum Health and MSU, Grand Rapids, MI, USA, 2MSU, Grand Rapids, MI, USA.

AORTIC ARCH ANATOMY IN PATIENTS WITH CAROTID AND AORTIC DISEASE
Background:
Vascular surgeons performing carotid stents and thoracic aorta endografts traverse the aortic arch and cannulate the great vessels routinely. Certain anatomic features render these diagnostic and therapeutic procedures more difficult.
Purpose:
To review the anatomical arch types, and degree of calcification encountered in patients undergoing diagnostic and therapeutic arch aortograms (AA).
Methods:
The digital subtraction angiograms of all patients subjected to AA were retrospectively reviewed. Classification included bovine type (common origin for innominate and left common carotid), and types I, II and III for great vessel takeoff. Other anomalies were noted as well as the extent of calcification present. Types of catheters used for selective cannulation were noted, as well as procedure complications and outcomes.
Results:
We randomly selected 320 patients (140 women) out of 478 patients subjected to AA. The average age was 69.5 (range 22 to 94). There were 175 (54%) AA performed for diagnostic purposes. The large majority (280; 89%) was for cerebrovascular disease, 21 (6.5%) for thoracic aortic disease, 9 for subclavian or upper extremity ischemia, and 5 for visceral aortic disease. After excluding 71 patients with inadequate views, we found 61 (19%) patients with bovine arch. Only 50 (20%) had a type I arch, while 167 (39%) had type II a and b, and 103 (41%) had type III. Moderate calcification was noted in 35 (14%) and severe in 6 (2.4%). Severe calcification and stenosis precluded selective cannulation in 3 patients. Severe disabling stroke occurred in 3 (0.9%) patients.
Conclusion:
Arch anatomy influences the choice of catheters and procedures performed in patients with carotid and aortic disease. We found a significant proportion of patients with difficult arch anatomy, particularly type III, complicating delivery of carotid stents and thoracic endografts.


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