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| Aortic arch | |
|---|---|
| Name | Aortic arch |
| Latin | arcus aortae |
| System | Cardiovascular system |
| Arteries | ascending aorta, descending aorta |
| Veins | none |
| Supplies | head, neck, upper limbs |
Aortic arch The aortic arch is the curved segment of the major artery that connects the Ascending aorta to the Descending aorta and gives rise to major arterial branches supplying the head, neck, and upper limbs. It lies within the superior mediastinum posterior to the Manubrium and anterior to the Trachea, situated between the origins of the Left ventricle outflow and the descending thoracic aorta. Surgical, radiologic, and embryologic descriptions of the aortic arch appear across works by investigators associated with institutions such as Harvard Medical School, Mayo Clinic, Johns Hopkins Hospital, Stanford University, and historical anatomists from University of Padua and University of Edinburgh.
The aortic arch typically gives rise to three major branches: the Brachiocephalic trunk, the Left common carotid artery, and the Left subclavian artery. Its relations include the Thymus (in infants), the Vagus nerve, the Phrenic nerve, and the Left recurrent laryngeal nerve which hooks below the arch near the Ligamentum arteriosum. The arch spans vertebral levels approximately T3–T4 and is bounded anteriorly by the Sternum and posteriorly by the Esophagus and Spine of T4. Anatomical descriptions feature in atlases from Netter and treatises from surgeons at Royal College of Surgeons and American College of Surgeons.
Embryologically, the aortic arch derives from patterns of the pharyngeal (branchial) arch arteries, notably the left fourth pharyngeal arch artery, interacting with structures studied by investigators at Max Planck Institute and described in texts from Guy's Hospital Medical School. Neural crest cells from regions associated with researchers at Karolinska Institutet contribute to arch remodeling; perturbations linked to syndromes characterized at Great Ormond Street Hospital and Boston Children's Hospital can produce persistent embryonic vascular segments. Developmental signaling pathways highlighted by groups at MIT and Dana-Farber Cancer Institute include perturbations observed in pedigrees documented through collaborations with NIH.
Common variants include an Aberrant right subclavian artery and a Bovine aortic arch configuration, terms used in surgical literature from Cleveland Clinic, Mount Sinai Hospital, and case series published by teams at Mayo Clinic. Pathologic anomalies include Coarctation of the aorta, double aortic arch, and interrupted aortic arch types classified in pediatric cohorts at Great Ormond Street Hospital and Children's Hospital of Philadelphia. Genetic and syndromic associations have been reported in centers such as Johns Hopkins Hospital and UCSF Medical Center with links to conditions first characterized at Boston Children's Hospital and in registries maintained by Eurocat.
The arch gives rise to the principal arteries supplying cranial and upper limb perfusion: the Brachiocephalic trunk (itself bifurcating into the Right common carotid artery and Right subclavian artery), the Left common carotid artery, and the Left subclavian artery. Branching patterns are catalogued in surgical atlases from Royal College of Surgeons and radiology protocols at Mayo Clinic and Cleveland Clinic. Collateral networks engaging the Internal thoracic artery and connections with vessels described in vascular studies at Oxford University support perfusion in obstruction scenarios noted in case reports from Johns Hopkins Hospital.
The arch functions as a conduit and pulse-dampening reservoir within the arterial tree; Windkessel effects originally discussed by physiologists at University of Cambridge and modeled by groups at Princeton University describe elastic recoil and systolic-diastolic buffering. Hemodynamic stresses at the arch influence atherosclerotic plaque distribution studied by researchers at Karolinska Institutet and Imperial College London. Computational fluid dynamics simulations from laboratories at Stanford University and ETH Zurich examine shear stress and vortex formation relevant to endovascular device planning at centers like Mayo Clinic.
Diseases involving the arch include atherosclerosis, aneurysm formation, dissection of the thoracic aorta, and traumatic transection; landmark surgical and endovascular interventions have been pioneered at Cleveland Clinic, Mount Sinai Hospital, Royal Brompton Hospital, and Johns Hopkins Hospital. Clinical guidelines from organizations such as the American Heart Association and European Society of Cardiology guide management of aneurysms and dissections. Arch-related compression syndromes involving the Esophagus and Trachea are managed in multidisciplinary centers including Great Ormond Street Hospital and Mayo Clinic.
Evaluation employs modalities developed and refined at institutions like Mayo Clinic, Johns Hopkins Hospital, and Massachusetts General Hospital: chest radiography, computed tomography angiography (CTA), magnetic resonance angiography (MRA), and transesophageal echocardiography (TEE). Endovascular planning and three-dimensional reconstructions reported by teams at Stanford University and Cleveland Clinic utilize fusion imaging and intravascular ultrasound techniques from trials coordinated with NIH and registries maintained by Society for Vascular Surgery.
Category:Arteries of the thorax