Anatomical organization of aortic arch variations in the India: embryological basis and review

TLDR

Accurate knowledge of aortic arch branch variants is essential for thoracic, head, and neck vascular surgery. The study aimed to quantify aortic arch variations in Indian cadavers and assess their clinical, surgical, and embryological significance. Branching patterns were examined in 62 formalin‑fixed Indian cadavers aged 45‑79, with dissections performed in the thoracic and cervical regions during routine undergraduate training at Kasturba Medical College, Mangalore. The usual three‑branched arch was present in 91.4 % of specimens, while 9.6 % exhibited variations—including common carotid origin (4.8 %), bi‑innominate sequence with left coronary artery from the aorta (1.6 %), right subclavian artery from the aorta (1.6 %), and left vertebral artery from the aorta (1.6 %); five of six anomalous cases were female, and one male had a left vertebral artery anomaly; overall, the spectrum of variations in Indians matches that of other populations.

Abstract

OBJECTIVES: To determine the percentage and type of aortic arch variations in Indian subjects and their clinical and surgical importance and embryological basis. PATIENTS AND METHOD: In our investigation, branching patterns of the aortic arch were studied in 62 formalin-fixed cadavers of both sexes of Indian origin, aged 45-79. The dissections were carried out in formalin-preserved cadavers and the aortic arch variations were observed after exposing the thoracic and cervical region during routine dissection of undergraduate students of Indian origin in Kasturba Medical College, Mangalore. RESULTS: The usual three-branched aortic arch was found in 56 cadavers (91.4%); variations were found in six cadavers (9.6%); 4.8% presented common origin of the carotid arteries; 1.6% had bi-innominate sequence, and the same specimen had left coronary artery arising from arch of aorta directly; 1.6% presented right subclavian artery arising directly from the aorta; 1.6% had left vertebral artery a branch of aortic arch. Five out of six cadavers with anomalous aortic arch branching pattern were females. One male cadaver presented anomalous origin of left vertebral artery directly from the arch. CONCLUSION: The wide spectrum of variations in the anatomical arrangements of the aortic arch branches in the Indian population was at par with other populations of the world. Although anomalous origins of the aortic arch branches are merely anatomic variants, accurate information about them is vital for vascular surgery in the thorax, head and neck region.