Preview

Russian Journal of Cardiology

Advanced search

Thoracic aortic geometry in patients with ascending aortic aneurysm and different anatomy of innominate artery

https://doi.org/10.15829/1560-4071-2025-6336

EDN: RXPFCO

Abstract

Aim. To analyze thoracic aortic geometry in patients with ascending aortic aneurysm in combination with normal or variant anatomy of innominate artery (IA).

Material and methods. The study included 72 patients with non-syndromic ascending aortic aneurysms, which were divided into 2 following groups depending on IA anatomy: patients with a common origin of innominate and left common carotid artery (CILCA, n=28) and patients with normal vessel (No CILCA, n=44). Based on multispiral computed tomography, the ascending aorta and aortic arch geometry were analyzed in all patients.

Results. Both groups of patients had ascending aortic aneurysm and aortic root dilatation without significant differences. The ascending aortic length in No CILCA patients was 113 [89; 144] mm vs 108 [63; 143] mm in CILCA patients (p=0,021). The length of tubular ascending aorta in No CILCA and CILCA patients was 86 [63; 123] mm and 82 [40; 103] mm, respectively (p=0,018). Compared to patients in the CILCA group, patients with normal IA anatomy were more often diagnosed with type III aortic arch (27,3% vs 3,6%, p=0,017) and less often with type I aortic arch (63,6% vs 89,3%, p=0,036).

Conclusion. Variant IA anatomy ("bovine arch") in patients with ascending aortic aneurysm does not worsen thoracic aortic geometry compared to patients with normal IA anatomy.

About the Authors

D. S. Panfilov
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation

Senior Research Scientist

Tomsk



E. A. Petrakova
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation

Post-graduate student, cardiovascular surgeon

Tomsk



V. V. Saushkin
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation

Cand. Sci. (Med.), Senior Research Scientist, Cardiologist

Tomsk



B. N. Kozlov
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation

Dr. Sci. (Med.), Head of the Department of Cardiovascular Surgery

Tomsk



References

1. Czerny M, Grabenwöger M, Berger T, et al.; EACTS/STS Scientific Document Group. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg. 2024;65(2). doi:10.1093/ejcts/ezad426.

2. Czerny M, Rylski B, Della Corte A, Krüger T. Decision-making to perform elective surgery for patients with proximal thoracic aortic pathology: A European perspective. J Thorac Cardiovasc Surg. 2022;163(6):2025-30. doi:10.1016/j.jtcvs.2021.01.141.

3. Heuts S, Adriaans BP, Rylski B, et al. Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection. Heart. 2020;106(12):8927. doi:10.1136/heartjnl-2019-316251.

4. Malakhova MV, Galyan TN, Khovrina AV, et al. Options for reducing radiation and iodine load during MSCT aortography before surgery on the aorta and aortic valve. Medical imaging. 2022;26(2):81-90. (In Russ.) doi:10.24835/1607-0763-1149.

5. Elefteriades JA, Sang A, Kuzmik G, Hornick M. Guilt by association: paradigm for detecting a silent killer (thoracic aortic aneurysm). Open Heart. 2015;2(1):e000169. doi:10.1136/openhrt-2014-000169.

6. Madhwal S, Rajagopal V, Bhatt DL, et al. Predictors of difficult carotid stenting as determined by aortic arch angiography. J Invasive Cardiol. 2008;20(5):200-4. doi:10.1007/9781-4614-7312-1_6.

7. Anfinogenova ND, Sinitsyn VE, Kozlov BN, et al. Existing and Emerging Approaches to Risk Assessment in Patients with Ascending Thoracic Aortic Dilatation. J Imaging. 2022;8(10):280. doi:10.3390/jimaging8100280.

8. Kozlov BN, Panfilov DS. Decision-making in thoracic aortic dilation: the state of the problem. Angiology and vascular surgery. 2023;29(2):157-60. (In Russ.) doi:10.33029/10276661-2023-29-2-157-160.

9. Panfilov DS, Saushkin VV, Sonduev EL, et al. Surgical treatment of ascending aortic aneurysms in men and women. Siberian Journal of Clinical and Experimental Medicine. 2022;37(3):108-13. (In Russ.) doi:10.29001/2073-8552-2022-37-3-108-113.

10. Isselbacher EM, Preventza O, Hamilton Black Iii J, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/ American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;80(24):223-393. doi:10.1016/j.jacc.2022.08.004.

11. Mansour AM, Peterss S, Zafar MA, et al. Prevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention. Cardiology. 2018;139(3):139-46. doi:10.1159/000481930.

12. Tozzi P, Gunga Z, Niclauss L, et al. Type A aortic dissection in aneurysms having modelled pre-dissection maximum diameter below 45 mm: should we implement current guidelines to improve the survival benefit of prophylactic surgery? Eur J Cardiothorac Surg. 2021;59(2):473-8. doi:10.1093/ejcts/ezaa351.

13. Ziganshin BA, Zafar MA, Elefteriades JA. Descending threshold for ascending aortic aneurysmectomy: Is it time for a "left-shift" in guidelines? J Thorac Cardiovasc Surg. 2019;157(1):37-42. doi:10.1016/j.jtcvs.2018.07.114.

14. Gulati A, Zamirpour S, Leach J, et al. Ascending thoracic aortic aneurysm elongation occurs in parallel with dilatation in a nonsurgical population. Eur J Cardiothorac Surg. 2023;63(6):ezad241. doi:10.1093/ejcts/ezad241.

15. Krüger T, Oikonomou A, Schibilsky D, et al. Aortic elongation and the risk for dissection: the Tübingen Aortic Pathoanatomy (TAIPAN) project†. Eur J Cardiothorac Surg. 2017;51(6):1119-26. doi:10.1093/ejcts/ezx005.

16. Wu J, Zafar MA, Li Y, et al. Ascending Aortic Length and Risk of Aortic Adverse Events: The Neglected Dimension. J Am Coll Cardiol. 2019;74(15):1883-94. doi:10.1016/j.jacc 2019.07.078.

17. Della Corte A, Rubino AS, Montella AP, et al. Implications of abnormal ascending aorta geometry for risk prediction of acute type A aortic dissection. Eur J Cardiothorac Surg. 2021;60(4):978-86. doi:10.1093/ejcts/ezab218.

18. Della Corte A, Lo Presti F, Saade W, et al. Acute type A aortic dissection in bicuspid versus tricuspid aortic valve patients: focus on geometrical features of the aorta. Eur J Cardiothorac Surg. 2023;63(2). doi:10.1093/ejcts/ezac576.

19. Toba T, Mori S, Izawa Y, et al. Ascending aortic elongation and correlative change in overall configuration of the proximal aorta in elderly patients with severe aortic stenosis. Clin Anat. 2020;33(8):1240-8. doi:10.1002/ca.23575.

20. Salmasi MY, Pirola S, Mahuttanatan S, et al. Geometry and flow in ascending aortic aneurysms are influenced by left ventricular outflow tract orientation: Detecting increased wall shear stress on the outer curve of proximal aortic aneurysms. J Thorac Cardiovasc Surg. 2023;166(1):11-21.e1. doi:10.1016/j.jtcvs.2021.06.014.

21. Mylonas SN, Barkans A, Ante M, et al. Prevalence of Bovine Aortic Arch Variant in Patients with Aortic Dissection and its Implications in the Outcome of Patients with Acute Type B Aortic Dissection. Eur J Vasc Endovasc Surg. 2018;55(3):385-91. doi:10.1016/j.ejvs.2017.12.005.

22. Kozlov BN, Panfilov DS, Petrakova EA. Association of Variant Arch Anatomy with Aortic Diseases. Minimally Invasive Cardiovascular Surgery. 2023;2(1):18-23. (In Russ.)

23. Dumfarth J, Chou AS, Ziganshin BA et al. Atypical aortic arch branching variants: A novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg. 2015;149(6):1586-92. doi:10.1016/j.jtcvs.2015.02.019.

24. Adriaans BP, Heuts S, Gerretsen S, et al. Aortic elongation part I: the normal aortic ageing process. Heart. 2018;104(21):1772-7. doi:10.1136/heartjnl-2017-312866.

25. Rylski B, Desjardins B, Moser W, et al. Gender-related changes in aortic geometry throughout life. Eur J Cardiothorac Surg. 2014;45(5):805-11. doi:10.1093/ejcts/ezt597.

26. Marrocco-Trischitta MM, Rylski B, Schofer F, et al. Prevalence of type III arch configuration in patients with type B aortic dissection. Eur J Cardiothorac Surg. 2019;56(6):1075-80. doi:10.1093/ejcts/ezz137.

27. Sun L, Li X, Li Q, et al. Morphological Features of Aortic Arch Predicting the Risk for Acute Type B Aortic Dissection. World J Surg. 2021;45(11):3458-66. doi:10.1007/s00268-02106247-5.


Supplementary files

  • Patients with a common origin of innominate and left common carotid artery, compared to patients with normal vessel anatomy, have shortened tubular ascending aorta, lengthened aortic root and arch, as well as higher rate of type I arch and lower rate of type III arch.

Review

For citations:


Panfilov D.S., Petrakova E.A., Saushkin V.V., Kozlov B.N. Thoracic aortic geometry in patients with ascending aortic aneurysm and different anatomy of innominate artery. Russian Journal of Cardiology. 2025;30(8):6336. (In Russ.) https://doi.org/10.15829/1560-4071-2025-6336. EDN: RXPFCO

Views: 290


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1560-4071 (Print)
ISSN 2618-7620 (Online)