Surgically Relevant Aortic Arch Mapping Using Computed Tomography

BackgroundRecent advances in surgical repair of aortic arch pathologies have increasingly used endovascular stent-graft technology. The purpose of this study was to map the aortic arch diameters, branch orientations, and center line distances using a commercially available three-dimensional computed tomography-based software package and to propose a prototype design.MethodsTeraRecon 3D imaging software was used for morphological assessment of computed tomography scans from 45 patients (mean age: 68 years; 26 males, 19 females). In each patient, 13 measurements were made in relation to the center line, including diameters at several preset points, distances, and branch vessel orientations.ResultsThe mode of the proximal diameters (2 cm and 4 cm distal to coronary artery) was 32 mm and 34 mm. The mode of the distance between the innominate and left common carotid arteries was 5 mm and 6 mm, and the mode of the distance between the left common carotid artery and left subclavian artery was 8 mm. Most commonly, the left common carotid artery was anterior to the other arch branches by 3 to 5 mm.ConclusionsThese anatomic measurements provide useful information for the advancement of minimally invasive and safer surgical repair of the aortic arch. Based on the most commonly observed measurements, a standardized off-the-shelf stent-graft is proposed that would be appropriate for the majority of patients.