Objectives. The aim was to determine the prevalence of aortic arch variations in 881 patients who underwent neck CT angiography for various reasons. Material and Methods. 881 patients were included in the study who had undergone neck CT angiography between 2010 and 2013. Results. Of 881 patients, 770 (87.4%) patients with classic branching pattern of the aortic arch (AA) were observed. Variations in branching pattern were seen in 111 (12.6%) patients. The most common variation was the origination of the left common carotid artery (LCCA) from the brachiocephalic trunk (BCT). This pattern was observed in 64 (7.2%) cases. In 25 (2.8%) cases, the left vertebral artery (LVA) originated directly from the AA between the origin of the LCCA and left subclavian artery (SCA). 17 (1.9%) cases had aberrant right subclavian artery. Three (0.3%) cases showed right aortic arch. Two cases had right aortic arch with aberrant left subclavian artery. Conclusions. Variations in the branching pattern of the AA are not rare. Head and neck surgeons and interventional radiologists should be aware of aortic arch variations. CTA is a reliable imaging method for demonstrating anatomical features and variations of the AA. 1. Introduction In the classical anatomical configuration, the aortic arch (AA) is left sided and the most common branching pattern of the AA comprises of three great vessels; first the brachiocephalic trunk (BCT), then the left common carotid artery (LCCA), and finally the left subclavian artery (SCA) from right to left. The BCT branches into right SCA and right common carotid artery (RCCA). This branching pattern occurs in 64.9–94.3% of the cases and it is described as “normal” [1–6]. Variations in the branching pattern of the AA range from differences in the origins of different branches to the number of branches [2, 4]. Development of the aorta takes place during the third week of gestation [5]. Six pairs of aortic arches, the so-called branchial arch arteries, develop between the ventral and dorsal aortae. These variations of the AA can be explained by persistence of segments of the aortic arches that normally regress or disappearance of segments that normally remain, or both [1, 5, 6]. Anatomical variations in the branching pattern of AA are significant for diagnostic, surgical, and interventional procedures of the thorax and neck. The purpose of this study is to review the computed tomography angiography (CTA) appearance of anatomical variations in branching pattern and position alterations of the AA and to determine the prevalence in 881 patients. 2.
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