Aortic Arch Variants: A Practical Guide to Safe and Timely Catheterization

Background: Variations in aortic arch anatomy have been extensively described from multiple perspectives including gross anatomy, embryology, associated cardiac and other anomalies, early life presentation, and cross-sectional diagnosis. There is however a paucity of literature with an emphasis on safe and timely catheterization, particularly when the variants are found during emergent or other catheter angiographic procedures without benefit of prior cross-sectional vascular imaging. The purpose of this review is to try to fill this gap. Methods: A review of past 1,000 diagnostic and therapeutic catheterizations was performed to identify arch variants, which are presented in order of frequency encountered at our institutions. Results: The variants are presented as illustrations and catheter angiographic images, with emphasis on safe and efficient intraprocedural diagnosis and catheterization. Conclusion: Familiarity with more and less common arch variants, along with low threshold for performance of pigtail aortic arch angiography and comfort in use of general purpose and recurved catheters, will ensure success in the vast majority of encountered variations.

Coagulation And Hem0Rhe0L0Gy In Cerebrovascular Disease. Differences Reated To Angiographic Findings And Sex

A series of 102 cerebrovascular patients (CVP) investigated with aortic arch angiography, carotidography and CAT scan, were classified clinically in STROKE (55) and TIA (47) and pathologically as having (IAL, 51) or having no (NIAL, 51) identifiable arterial lesions. Coagulation and hemorheologic tests were performed at least 3 months after STROKE or 1 month after a TIA episode. All CVP as compared to controls (84) had significantly higher fibrinogen (Fg), F VIII AHF and RAg, blood (BV) and plasma (PV) viscosity, and poorer erythrocyte deformability (ED, as filtered erythrocyte volume, FEV), but no differences in euglobulin lysis time (ELT) even after venostasis (ELTV) and in circulating platelet aggregates (CPA, as 1/PAR). IAL vs NIAL CVP had higher Fg (mg% 285±74 vs 241±64; p<0.005); a trend to higher BV (cp 4.64±0.5 vs 4.53±0.6) and PV (cp 1.63±0.15 vs 1.58±0.15), but no differences in other parameters. In the subgroup IAL-STROKE more CPA (1/PAR 121±18) were found vs IAL-TIA (1/PAR 104±13; p<0.05). When compared to sex-matched controls CV males had more Fg (269±36 vs 220±38; p<0.01), higher BV (p<0.05) and PV (1.61±0.16 vs 1.45±0.13; p<0.001), and poorer ED (FEV ml/min 7.41±2.8 vs 10.6±3.2; p<0.005). CPA were higher in CV males than in CV females (1/PAR 122±31 vs 96±36, p<0.05). Conversely, CV females differed from their controls only for a higher PV (p<0.05). This study points out that most of the parameters considered, are especially altered in CV males rather than in CV females, thus suggesting sex-related differences in response to drugs acting on haemostasis and rheology in CV diseases.