Identification of Different Arch Types and Possible Implications for Endovascular Repair of the Aortic Arch

Objectives: Endovascular treatment of aortic arch pathologies are continuously evolving. Presently, available stent grafts often do not perfectly fit anatomical demands. Detailed anatomical studies are of particular interest for optimized stent design. The present study evaluated different aortic arch geometries and corresponding implications for a theoretical stent design.

Patients and Methods: A total of 152 consecutive patients underwent computed tomography of the chest. Patients with aortic disease were excluded. Specific anatomical features, angles and diameters of the aortic arch were evaluated.

Results: Generally, a high variability of aortic arch anatomy was found, particularly with regard on take-off points and angles of the supra-aortic vessels. The aorta showed a continuous tapering with a ¼ diameter reduction of its course. Three recurrent types of aortic arch geometry were identified: (1) the classic arch with an angle between the 2nd and 3rd quadrant < 40 degrees in 61 patients, (II) a gothic configuration with an angle between the 2nd and 3rd quadrant >40 degrees in patients, and (III) an rectangle arch in 20 patients, characterized by an orthogonal aortic course after the switchover from 1st to 2nd quadrant and a change of the tangential vector < 5 degrees during the further course. Type I without pointed angles promises better results of endovascular treatment compared with Type II arch configuration. In type III good results can be expected if the implantation zone does not include the orthogonal kink.

Conclusion: Aortic arch mapping using three-dimensional computed tomography identified three frequently recurrent arch geometries. Potential implications for the success of endovascular treatment were deduced.

Fig. 1