Identifying Aortic Arch Branching Variations Using Advanced Imaging Techniques

Background and Objectives: The branching pattern of the aortic arch (AA) is highly variable, with the typical supra-aortic branching configuration observed in about three out of four cases. Even though some variants carry a heightened risk for certain diseases and intraoperative complications, they are often underrepresented in standard textbooks. One of the earliest meta-analyses on this topic was published by Dr. Herbert Lippert in 1967. This study aims to use modern imaging to identify AA variations, compare the prevalence with Lippert's findings, and evaluate the relevance of his classification in today's Central European population. Materials and Methods: Computed tomography angiography (CTA) scans of 400 patients were retrospectively analyzed and categorized according to Lippert's classification of AA variations. The prevalence of each variation was calculated and compared to the results reported by Lippert. Results: The typical AA branching was observed in 75.5% of cases. Brachiocephalic trunk variations were the second most common, occurring in 19.5% of patients. Variations involving the left vertebral artery branching directly off the AA had a prevalence of 4%. Additionally, two cases (0.5%) exhibited a thyroidea ima artery originating from the AA, and two cases (0.5%) demonstrated an arteria lusoria with a retroesophageal course. Conclusions: Lippert's classification remains highly relevant in describing supra-aortic branching pattern prevalence within today's Central European population. Although most variants are of limited clinical relevance, some can become symptomatic or cause complications during medical interventions. Awareness of these variations is therefore essential for optimal patient care.