title: Aortic Arch Morphology and Aortic Length in Patients with Dissection, Traumatic, and Aneurysmal Disease.
abstract: OBJECTIVE
  To assess aortic arch morphology and aortic length in patients with dissection, traumatic injury, and aneurysm undergoing TEVAR, and to identify characteristics specific to different pathologies.
  
  
  METHODS
  This was a retrospective analysis of the aortic arch morphology and aortic length of dissection, traumatic injury, and aneurysmal patients. Computed tomography imaging was evaluated of 210 patients (49 dissection, 99 traumatic injury, 62 aneurysm) enrolled in three trials that received the conformable GORE TAG thoracic endoprosthesis. The mean age of trauma patients was 43 ± 19.6 years, 57 ± 11.7 years for dissection and 72 ± 9.6 years for aneurysm patients. A standardized protocol was used to measure aortic arch diameter, length, and take-off angle and clockface orientation of branch vessels. Differences in arch anatomy and length were assessed using ANOVA and independent t tests.
  
  
  RESULTS
  Of the 210 arches evaluated, 22% had arch vessel common trunk configurations. The aortic diameter and the distance from the left main coronary (LMC) to the left common carotid (LCC) were greater in dissection patients than in trauma or aneurysm patients (p < .001). Aortic diameter in aneurysm patients was greater compared with trauma patients (p < .05). The distances from the branch vessels to the celiac artery (CA) were greater in dissection and aneurysm patients than in trauma patients (p < .001). The take-off angle of the innominate (I), LCCA, and left subclavian (LS) were greater, between 19% and 36%, in trauma patients than in dissection and aneurysm patients (p < .001). Clockface orientation of the arch vessels varies between pathologies.
  
  
  CONCLUSIONS
  Arch anatomy has significant morphologic differences when comparing aortic pathologies. Describing these differences in a large sample of patients is beneficial for device designs and patient selection.
authors.affiliation: School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA. Electronic address: alberta@surgery.wisc.edu.
authors.forename: H B
authors.initials: HB
authors.lastname: Alberta
authors.affiliation: School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: T
authors.initials: T
authors.lastname: Takayama
authors.affiliation: School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: Smits
authors.affiliation: School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA; W. L. Gore & Associates, Flagstaff, AZ, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: Wendorff
authors.affiliation: Division of Vascular Surgery and Endovascular Surgery, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Cambria
authors.affiliation: Division of Vascular Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Farber
authors.affiliation: Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: W D
authors.initials: WD
authors.lastname: Jordan
authors.affiliation: Division of Vascular Surgery and Endovascular Surgery, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: V
authors.initials: V
authors.lastname: Patel
authors.affiliation: Department of Cardiothoracic & Vascular Surgery, University of Texas Houston Medical School, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Azizzadeh
authors.affiliation: Morton Plant Hospital Valve and Structural Heart Center, Clearwater, FL, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Rovin
authors.affiliation: School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Matsumura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D014481:United States; D057772:Vascular System Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult
keywords: Aneurysm; Aortic arch; Aortic length; Aortic morphology; Dissection; Traumatic injury