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The apex of the aortic arch backshifts with aging

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Background

Only a few studies, involving small numbers of patients, have globally assessed the curvature of the thoracic aorta but without any details concerning the location of the supra-aortic trunks.

Objectives

Using CT to describe normal aortic-arch morphology and its changes with age and sex.

Methods

344 CT scans were studied. We measured the distances from the apex to the ascending and descending aorta, the curvilinear length of the entire arch, that of the segment, including bifurcations of supra-aortic vessels, and the angle, height, and shift of the arch.

Results

In men, the arch was significantly longer (146.2 vs 122.8 mm; p < 0.001), higher (49.3 vs 40.1 mm, p < 0.001), and wider transversely (83.6 vs 73.3 mm; p < 0.001) than in women. The average men’s arch also had a more acute angle at the apex (79.7° vs 83.7° p < 0.001). Neither morphology nor age influenced the winding angle around the mediastinum. Aging was accompanied by deflection and extension of the aortic arch, which grew more anteroposteriorly (6.1 mm/10 years in men) than vertically (2.5 mm/10 years in men), while the apex moved towards the rear of the arch. The ascending aorta was the only curvilinear length unaffected by age, whereas the supra-aortic trunks parted from each other.

Conclusion

We believe that all these original observations could lead to a better assessment of normal aging of the aorta and guide technical choices during surgical or hybrid procedures.

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Abbreviations

AC:

Ascending aortic-arch length

ACD:

Apex angle of the aortic arch

ACsD:

Helix angle of the aortic arch

AD:

Transverse length of the aortic arch

BCT:

Brachiocephalic arterial trunk

BMI:

Body mass index

BSA:

Body-surface area

CCp:

Aortic-arch height

CD:

Descending length of the aortic arch

CDA:

Descending angle of the aortic arch

CT Scan:

Computed tomography scan

DAC:

Ascending angle of the aortic arch

LCCA:

Left common carotid artery

LSCA:

Left subclavian artery

PACS:

Picture archiving and communication system

References

  1. Casciaro ME, Craiem D, Chironi G et al (2014) Identifying the principal modes of variation in human thoracic aorta morphology. J Thorac Imaging 29:224–232. doi:10.1097/RTI.0000000000000060

    Article  PubMed  Google Scholar 

  2. Claudot F, Alla F, Fresson J et al (2009) Ethics and observational studies in medical research: various rules in a common framework. Int J Epidemiol 38:1104–1108. doi:10.1093/ije/dyp164

    Article  PubMed  PubMed Central  Google Scholar 

  3. Craiem D, Chironi G, Redheuil A et al (2012) Aging impact on thoracic aorta 3D morphometry in intermediate-risk subjects: looking beyond coronary arteries with non-contrast cardiac CT. Ann Biomed Eng 40:1028–1038. doi:10.1007/s10439-011-0487-y

    Article  PubMed  Google Scholar 

  4. Garcier J-M, Petitcolin V, Filaire M et al (2003) Normal diameter of the thoracic aorta in adults: a magnetic resonance imaging study. Surg Radiol Anat 25:322–329. doi:10.1007/s00276-003-0140-z

    Article  PubMed  Google Scholar 

  5. Hager A, Kaemmerer H, Rapp-Bernhardt U et al (2002) Diameters of the thoracic aorta throughout life as measured with helical computed tomography. J Thorac Cardiovasc Surg 123:1060–1066. doi:10.1067/mtc.2002.122310

    Article  PubMed  Google Scholar 

  6. Hinchliffe RJ, Krasznai A, Schultzekool L et al (2007) Observations on the failure of stent-grafts in the aortic arch. Eur J Vasc Endovasc Surg 34:451–456

    Article  CAS  PubMed  Google Scholar 

  7. Lin FY, Devereux RB, Roman MJ et al (2008) Assessment of the thoracic aorta by multidetector computed tomography: age- and sex-specific reference values in adults without evident cardiovascular disease. J Cardiovasc Comput Tomogr 2:298–308. doi:10.1016/j.jcct.2008.08.002

    Article  PubMed  Google Scholar 

  8. Malkawi AH, Hinchliffe RJ, Yates M et al (2010) Morphology of aortic arch pathology: implications for endovascular repair. J Endovasc Ther 17:474–479

    Article  PubMed  Google Scholar 

  9. Melissano G, Bertoglio L, Civilini E et al (2007) Results of thoracic endovascular grafting in different aortic segments. J Endovasc Ther Off J Int Soc Endovasc Spec 14:150–157. doi:10.1583/1545-1550(2007)14[150:ROTEGI]2.0.CO;2

  10. Mosteller RD (1987) Simplified calculation of body-surface area. N Engl J Med 317:1098. doi:10.1056/NEJM198710223171717

    CAS  PubMed  Google Scholar 

  11. Rogers IS, Massaro JM, Truong QA et al (2013) Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study). Am J Cardiol. doi:10.1016/j.amjcard.2013.01.306

    PubMed Central  Google Scholar 

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

    Google Scholar 

  13. Rylski B, Blanke P, Beyersdorf F et al (2014) How does the ascending aorta geometry change when it dissects? J Am Coll Cardiol. doi:10.1016/j.jacc.2013.12.028

    PubMed  Google Scholar 

  14. Schlatmann TJ, Becker AE (1977) Histologic changes in the normal aging aorta: implications for dissecting aortic aneurysm. Am J Cardiol 39:13–20

    Article  CAS  PubMed  Google Scholar 

  15. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428

    Article  CAS  PubMed  Google Scholar 

  16. Stefanadis C, Stratos C, Vlachopoulos C et al (1995) Pressure-diameter relation of the human aorta. A new method of determination by the application of a special ultrasonic dimension catheter. Circulation 92:2210–2219

    Article  CAS  PubMed  Google Scholar 

  17. Stefanadis C, Dernellis J, Vlachopoulos C et al (1997) Aortic function in arterial hypertension determined by pressure-diameter relation: effects of diltiazem. Circulation 96:1853–1858

    Article  CAS  PubMed  Google Scholar 

  18. Stefanadis C, Dernellis J, Tsiamis E et al (2000) Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischaemic heart disease. Eur Heart J 21:390–396. doi:10.1053/euhj.1999.1756

    Article  CAS  PubMed  Google Scholar 

  19. Wolak A, Gransar H, Thomson LEJ et al (2008) Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area. JACC Cardiovasc Imaging 1:200–209. doi:10.1016/j.jcmg.2007.11.005

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Heart Surgery Department, Clermont-Ferrand University Hospital, Place H. Dunant, 63000, Clermont-Ferrand, France

    N. d’ostrevy, K. Azarnoush & L. Camilleri

  2. Radiology Department, Clermont-Ferrand University Hospital, 63000, Clermont-Ferrand, France

    F. D. Ardellier & L. Cassagnes

  3. ISIT-UMR 6284 UdA-CNRS, Institut des Sciences de l’Image pour les Techniques interventionnelles, Clermont Université, Université d’Auvergne, BP 10448, 63000, Clermont-Ferrand, France

    N. d’ostrevy, L. Cassagnes, L. Ouchchane & L. Camilleri

  4. Laboratoire de Biostatistique Informatique Médicale et Technologies de Communication, University Clermont1, 63000, Clermont-Ferrand, France

    L. Ouchchane

  5. INRA, UMR 1019 Nutrition Humaine, 63122, Saint Genès Champanelle, France

    K. Azarnoush

  6. Laboratoire d’anatomie, University Clermont1, 63000, Clermont-Ferrand, France

    L. Sakka

Authors
  1. N. d’ostrevy
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  2. F. D. Ardellier
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  3. L. Cassagnes
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  4. L. Ouchchane
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  5. K. Azarnoush
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  6. L. Camilleri
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  7. L. Sakka
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Corresponding author

Correspondence to N. d’ostrevy.

Ethics declarations

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. This descriptive, retrospective monocentric study was conducted according to ethical principles for medical research involving human subjects in French university hospitals (Claudot F, et al. Ethics and observational studies in medical research: various rules in a common framework. Int J Epidemiol 2009, 38(4):1104–1108.)

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d’ostrevy, N., Ardellier, F.D., Cassagnes, L. et al. The apex of the aortic arch backshifts with aging. Surg Radiol Anat 39, 703–710 (2017). https://doi.org/10.1007/s00276-016-1792-9

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  • DOI: https://doi.org/10.1007/s00276-016-1792-9

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