A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch

J Vasc Surg. 2018 Jul;68(1):298-306.e10. doi: 10.1016/j.jvs.2017.06.097. Epub 2017 Aug 31.


Objective: The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants.

Methods: A systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed.

Results: A total of 51 articles were included (N = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations.

Conclusions: Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Aneurysm / diagnostic imaging
  • Aneurysm / epidemiology*
  • Aorta, Thoracic / abnormalities*
  • Aorta, Thoracic / diagnostic imaging
  • Black People
  • Brachiocephalic Trunk / abnormalities*
  • Brachiocephalic Trunk / diagnostic imaging
  • Cardiovascular Abnormalities / diagnostic imaging
  • Cardiovascular Abnormalities / epidemiology*
  • Carotid Arteries / abnormalities*
  • Carotid Arteries / diagnostic imaging
  • Humans
  • Incidence
  • Prevalence
  • Prognosis
  • Subclavian Artery / abnormalities*
  • Subclavian Artery / diagnostic imaging
  • Vertebral Artery / abnormalities*
  • Vertebral Artery / diagnostic imaging

Supplementary concepts

  • Aberrant subclavian artery