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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax: Aorta: Arch and Thoracic part of the Descending Aorta

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax

Aorta: Arch and Thoracic part of the Descending Aorta

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


The aorta may vary in its position and extent without any other irregularities. The height of the arch may be as high as the level of the third dorsal (thoracic) vertebra or as low as the fifth thoracic. The summit of the arch may reach the top of the sternum. The distance that the aorta extends downward depends on the point of its division into the common iliac arteries. The point of the division may be as high as the third lumbar vertebra (in some rare cases higher) or as low as the fifth lumbar vertebra.

A very remarkable variation of the descending aorta consists in the more or less division of the vessel through a part or even the entire channel by a median septum, which is explained by assuming that the fusion of the embryonic original doubled aorta was incomplete.

The varieties of the aortic arch are intimately associated with the development of the fourth arterial arches. The usual aortic arch in man, and of all mammalia, is a left one produced by the persistence and development of the left fourth arch; in birds it is the right fourth arch which forms the permanent aorta; and in reptiles both the right and left fourth arches remain patent.

In cases where there is a complete lateral transposition, which is occasionally seen in the aortic arch and pulmonary arteries, as well in the great veins and the several divisions of the heart, may only affect these parts (dextrocardia), or this transposition may be accompanied by a similar transposition of the viscera of the body (situs inversus). Such cases usually do not have any malfunction and are only a mirror image of the usual structural condition.

The aortic arch has been found to be doubled in rare cases, which may be explained on the supposition that both the right and left fourth arches have remained open and continued to develop. In these cases, the ascending aorta divides into two branches which pass backwards surrounding the trachea and esophagus, and then joining on the left side of the spine to form the descending aorta. Each arch gives rise to the common carotid and subclavian arteries of its own side. References are given in the listing following the text and illustrations. Although inconsistent with modes of development of the vascular arches, a case (Malacarne's) was found where the ascending aorta divided close to the heart, and the two arches enclosed the trunk of the pulmonary artery, as well as the trachea and esophagus, and each gave rise to a subclavian, and external and an internal carotid.

The existence of a right aortic arch, that is one passing to the right of the trachea and esophagus is believed to be caused by the development of the fourth right arch rather than the usual left arch; and accordingly there are instances of this variety without any deviations of any other structures except that the brachiocephalic (innominate) is a left sided one and the succeeding vessels are the right carotid and right subclavian. The recurrent laryngeal nerve forms its sling on the right side around the arch of the aorta, and on the left side around the arch of the subclavian artery. In the majority of the cases of right aortic arch there is a further irregularity affecting the origin of the the left subclavian artery which arises as the last branch of arch or first branch of the descending aorta.

Variations in the posterior part of the arch and ductus arteriosus belong to the changes in that part of the primitive dorsal aorta (the posterior aortic root) that intervenes between the termination of the fourth arch and the spot where the two trunks unite to form the single descending aorta. Under usual conditions this part persists on the left side, but is obliterated on the right.The most frequent variety of this is that of the subclavian artery (of the right side when the aortic arch is left or typical) arising from the back part of the arch, or fourth in the series of vessels preceeding therefrom, a condition in which the subclavian artery is continued from the primitive dorsal aorta, while the usual channel through the fourth arch is closed. In such cases, the subclavian artery takes its course behind the trachea and esophagus to reach its usual place between the scalene muscles and over the first rib, and the inferior laryngeal nerve is not recurrent, but passes directly to the larynx without being drawn down as a loop by the subclavian artery.

A similar variation may occur with a right aortic arch, and the left subclavian artery is then found to arise from the dorsal extremity of the arch, which represents a persistent part of the primitive dorsal aorta, that also receives the insertion of the ligamentum arteriosum.The left recurrent laryngeal nerve forms a loop below the arch thus constituted by the ligamentum arteriosum and the beginning of the subclavian artery.

In many cases of these unusual subclavian arteries, just referred to, the vertebral artery is detached from the subclavian, and arises from the aorta in common with the right carotid artery. Here the subclavian is derived from the dorsal aorta, while the vertebral is continued from the fourth arch, the connection of the latter with the dorsal aorta being obliterated. In such cases, the inferior laryngeal nerve passes inward to the larynx around the first part of the vertebral artery. There are also examples of the converse of this situation, the vertebral of the right side having a dorsal origin, and passing behind the trachea and esophagus to its usual place, while the subclavian is continued from the fourth arch.

The ascending aorta is occasionally doubled. In one case the vessel bifurcated 8 mm after its origin into a right and left trunk, each providing the vessels of that side before reuniting to form the descending aorta.

The variations or absence of the arch of the aorta are usually based on persistent fetal conditions and may be associated with abnormalities of the heart. Many of the variations are due to different modes of transformation of the primary vessels of the branchial arches, especially the fourth. Since the aorta and the pulmonary artery develop from a common conus arteriosus, irregular and imperfect development of the septum between them may also produce variations.

At one stage of development, two aortic arches, a right and a left, are present, and such a condition occasionally persists in the adult. In such cases, since the portion of the aorta derived from the bulbus arteriosus is directed upward and to the right and the descending aorta is lying to the left side of the vertebral column, a right arch passes from right to left behind the trachea and esophagus. A left arch may curve over the right bronchus.

Rarely, the aortic arch is doubled forming a ring around the trachea. The ring closes as a single descending aorta. A double aortic arch is the result of the persistence of both fourth branchial arterial arches. The two arches fuse with the dorsal aortae to form the descending aorta. Most commonly a large right aortic arch passes to the right of the esophagus and trachea in a posterior direction, then turns to the left, passing behind the esophagus and trachea, and then joins with a small left aortic arch. This small left aortic arch passes laterally to the left in front of the trachea and then turns posteriorly to join the right aortic arch, and the left common carotid artery and the left subclavian artery arise from the left aortic arch. Hommel published the first description of a double aortic arch in 1737 (see illustration). There are two types of double aortic arch. One has a large right arch with a retro-esophageal component and a left descending aorta. The second, more rare, type has a large left arch with a retro-esophageal component and a right descending aorta. There is considerable variation in the relative sizes of the components of a double aortic arch. A double aortic arch occurs more commonly with a left descending aorta than with a right descending aorta. According to Griswald and Young, it is unusual for a double aortic arch to be associated with a malformation of the heart, it is less rare in association with other vascular variations.

Another variation is a single aortic arch curving to the right instead of to the left. This may be due to the persistence of the lower portion of the right dorsal aorta and the disappearance of the left, and may be associated with a complete inversion of all of the viscera, situs inversus.

If the inferior portion of the right dorsal aorta involutes, and the part that normally forms the proximal portion of the right subclavian persists, the right subclavian arises from the descending portion of the aortic arch. In such cases the subclavian passes either behind the eosphagus or between the trachea and esophagus (arteria subclavia dextra lusoria, ASDL) to reach the right side of the body (Bayford's case [1789, published in 1794] is fascinating reading).This variation was found in 312 of 22,271 individuals (all listed sources) or 1.4%.

Arteria Subclavia Dextra Lusoiria (ASDL)

Method of
Observation

Author

No. Cases

ASDL

Cadavers

Radiol.

Surg.

Goldbloom (1922)

225

4

*

Cairney (1924)

2,494

231

*

Abbot (1936)

1,000

7

*

Reed (1943)

58

3

*

Bahnson/Blalock (1950)

841

18

*

*

Gross/Neuhauser (1951)

40

10

*

*

Turner (1951)

192

5

*

Saegesser (1952)

8,500

13

*

Pattinson (1953)

5,407

7

*

Edwards (1956) After Goldbloom, 1922 and Jacob and Leru, 1970.

3,739

18

*

By 1899, Holzapfel had collected 200 cases of anomalous right subclavian arteries (ASDL). In addition, his literature review is outstanding. Many of these articles are cited in the present bibliography provided at the end of this section.

An aortic arch (right) having the left subclavian as the first branch has been reported.

Another group of variations is based on the persistence of the ductus arteriosus, which is derived from the sixth branchial arch vessel. In some rare cases that are accompanied by a partial or complete closure of the aorta (coarctation), life may be maintained after birth if a collateral circulation for the aorta is established. Included in this group of variations are cases in which the pulmonary artery arises from the aorta, and the blood of the pulmonary arteries passes from the aorta through the ductus arteriosus. In truncus arteriosus, a single vessel leaves the heart and supplies systemic, pulmonary, and coronary arteries. The incidence of common aorticopulmonary trunk is about 0.7% in cases of congenital heart disease and it occurs in about 0.0086% of live births. In most cases the truncus arises over both ventricles, which have large ventricular septal defects. There are numerous variations, including the following: a single pulmonary trunk and ascending aorta arising from the truncus; left and right pulmonary arteries arising independently from the truncus; associated aortic arch atresia or hypoplasia; unilateral absence of one pulmonary artery (usually on the side of the arch), with the second pulmonary artery arising from the truncus; and so on.

A ductus arteriosus was found draining into the left subclavian artery in a 25-year-old man.

Many variations occur in the number and position of vessels arising from the aortic arch. There may be as few as one or as many as six branches. The formation of a single branch involves the fusion of the two aortic stems and a shortening of the arch (no true arch) so that the ascending aorta gives rise to the left subclavian, left common carotid, and right brachiocephalic. A vertically descending branch of the aorta enters the abdominal cavity. A more common form is that found in most apes, in which the brachiocephalic and left common carotid unite to form one branch.

The avian form, with two arterial branches, is extremely rare in man. The following combinations have been reported:

(a) the right common carotid and right subclavian arising from the arch, and the left common carotid and left subclavian with other branches arising from the descending aorta;

(b) two brachiocephalics (bi-innominate), with side branches arising symmetrically;

(c) two brachiocephalics, with the right giving both common carotids and the left both subclavians;

(d) right common carotid and left brachiocephalic with the right subclavian arising from the descending aorta;

(e) both carotids arising from a common stem and a left subclavian, and a right subclavian arising from the descending aorta;

(f) a right arch replacing the left, one trunk arising from the arch proper, which divides into the left common carotid, right common carotid, and right subclavian, and the left subclavian arising low on the arch, i.e. the descending part.

In rare instances, variations of the usual three branches and their arrangement are found. With the aorta arching (usually) to the left, the order of the branching may be as follows:

(a) right subclavian, right carotid, left brachiocephalic;

(b) right brachiocephalic, left subclavian, left carotid;

(c) right subclavian, a bicarotid trunk, left subclavian;

(d) a bicarotid trunk, left subclavian, right subclavian;

(e) a bicarotid trunk, right subclavian, left subclavian;

(f) the brachiocephalic providing the left carotid, the left vertebral arising from the aortic arch;

(g) the brachiocephalic providing the left carotid, the left subclavian providing the left vertebral.

With the aorta arching to the right (no concomitant situs inversus), the order of branching may be as follows:

(a) left brachiocephalic, right common carotid, right subclavian;

(b) left carotid, right carotid, right subclavian, the left subclavian arising from a patent ductus arteriosus;

(c) right subclavian, right carotid, left carotid, the left subclavian arising from a patent ductus arteriosus.

When there are more than three branches, the vertebral arteries are usually added or the extra branch may be the thyroid ima, which ascends in front of the trachea to the thyroid gland. A common form, with four vessels, is one in which the left vertebral arises between the left carotid and the left subclavian. The following order of branchings have also been reported:

(a) right carotid, right subclavian, left carotid, left subclavian;

(b) right carotid, left carotid, right subclavian, left subclavian;

(c) right carotid, left carotid, left subclavian, right subclavian (from descending aorta). This variation has an incidence of about 0.4%;

(d) left carotid, right carotid, right subclavian, left subclavian;

(e) left carotid, right carotid, left subclavian, right subclavian;

(f) bicarotid trunk, left vertebral, left subclavian, right subclavian (retroesophageal);

(g) right subclavian, right carotid, left carotid, left subclavian (absence of innominate artery);

(h) right brachiocephalic trunk, left carotid, left vertebral, left subclavian;

(i) the usual branches (80% of cases), right brachiocephalic, left common carotid, left subclavian. If a vertebral is present, the left more frequently than the right vertebral, then the variation of four vessels has a frequency of about 5%;

(j) right brachiocephalic trunk, left common carotid, right vertebral, left subclavian;

(k) right brachiocephalic trunk, left carotid, left subclavian, left vertebral;

(l) right brachiocephalic trunk, left carotid, left subclavian, right subclavian;

(m) right brachiocephalic trunk, left vertebral, left subclavian, right subclavian;

(n) right subclavian, bicarotid trunk, left vertebral, left subclavian;

(o) right innominate (with right carotid and right internal thoracic branches), left carotid, left subclavian, right subclavian

(p) right brachiocephalic trunk, left carotid, left subclavian, right vertebral;

(q) right brachiocephalic trunk, left internal carotid, left external carotid, left subclavian;

In cases of right aortic arch:

(r) left carotid, right carotid, right subclavian, left subclavian;

(s) right brachiocephalic trunk, right internal thoracic, left carotid, left subclavian;

(t) right brachiocephalic trunk, right inferior thyroid, left carotid left subclavian;

(u) right brachiocephalic trunk, left carotid, left inferior thyroid, left subclavian;

(v) right brachicephalic trunk, left carotid, left superior intercostal, left subclavian;

(w) right brachiocephalic trunk, left thymic, left carotid, left subclavian.

When there are five arteries, the extra branches are usually the right subclavian and the left vertebral. The right subclavian artery, if it is the last branch, will be retroesophageal. However, additions to the usual complement of three may include an internal and an external carotid in place of a common carotid, or two vertebrals. In the absence of the brachiocephalic, the subclavian, common carotid, and one vertebral are branches of the arch. The reported order of branching follows:

(a) right brachiocephalic, right vertebral, left carotid, left vertebral, left subclavian;

(b) right brachiocephalic, left carotid, left vertebral, left subclavian, right subclavian (from descending aorta);

(c) right subclavian, right carotid, left carotid, left vertebral, left subclavian;

(d) right carotid, left carotid, left vertebral, left subclavian, right subclavian (from descending aorta);

(e) right carotid, left carotid, left subclavian, left vertebral, right subclavian (from descending aorta;

(f) right brachiocephalic, right internal thoracic, left carotid, left vertebral, left subclavian.

In cases of right arch; (g) left carotid, right carotid, right vertebral, right subclavian, left subclavian; also

(h) innominate with left carotid and left vertebral branches, right carotid, right vertebral, right subclavian, left subclavian.

Cases of six branches result from the separate origin for both vertebrals and both subclavians. Additional examples of branching order include the following:

(a) with a doubled aortic arch, a subclavian, external carotid, and internal carotid arise successively on the right and left side.

(b) right subclavian, right vertebral, right carotid, left carotid, left vertebral, left subclavian; and

(c) innominate artery with a thyroidea ima branch, two vertebrals, left inferior thyroid, left subclavian.

In about 80% of people, the branching order is right brachiocephalic trunk, left common carotid, and left subclavian; in 11%, a common stem exists for the brachiocephalic and left common carotid, with the left subclavian arising independently from the arch.

Uncommonly, the three usual branches are accompanied by less signifficant branches:

(a) a left thymic;

(b) a right internal thoracic;

(c) a right inferior thyroid;

(d) a thyroidea ima; or

(e) a left ventricular coronary.

The following arteries have been found arising from the aortic arch:

(a) external carotid;

(b) internal carotid;

(c) right vertebral;

(d) inferior thyroid;

(e) thymic;

(f) thyroidea ima; and

(g) left coronary.

In rare instances, the lower parts of the lungs may receive anomalous arteries from the thoracic aorta (or the upper part of the abdominal aorta). The thoracic aorta may give rise to a right subclavian (seen at levels T2,T3, and T4), a superior or supreme intercostal, or a renal artery, which descends through the aortic hiatus.

A classification of major variations of the aortic arch given by Gross and Ware (1946) and Neuhauser (1946) follows:

1) Right Aortic Arch
A. Situs Inversus Viscerum.
B. Right Aortic Arch without Inversion.
i)Anterior type.

The aortic arch is anterior to the trachea, and the descending aorta is on the right side.

ii) Posterior type.

The aorta passes to the left behind the esophagus and the descending aorta courses to the right of the normal left-sided position.

a.) Right aortic arch in which the subclavian artery arises last from the arch and crosses behind the esophagus to its distribution in the arm.

b.) Right aortic arch in which no vessel arising from the arch crosses the midline posterior to the esophagus.

c.) Right aortic arch with a persistent left aortic diverticulum giving origin to the left subclavian artery. No vessel from the arch crosses the midline posteriorly.

2) Double Aortic Arch

A. Both aortic limbs are patient.
B. One aortic limb obliterated.
3) Anomalous Right Subclavian Artery.

The artery arises last from a normal aortic arch and crosses the midline to its distribution on the right side (from behind the trachea or the trachea and esophagus).

4) Patent Ductus Arteriosus.
5) Coarctation of the Aorta.

Another Classification of Aortic Arch Variations have been provided by Kirklin and Clagett and is given as follows.

1. Left-sided descending aorta

A. Functioning double aortic arch.
1. Arches of approximately equal size.
2. One arch narrowed (usually but not always the anterior or left one).
B. Double aortic arch with partial atresis of one arch.
C. Right-sided aortic arch with retroesophageal segment and left-sided
descending aorta.
1. Left subclavian artery originating from left-sided aortic diverticulum.
2. Left subclavian artery originating from left innominate artery.
D. Left-sided aortic arch.
1. Right subclavian artery arising from the distal portion of the aortic arch from
the descending aorta and passing to the right usually behind the the
esophagus.
2. Normal arch and normal branches.
E. Right-sided ductus arteriosus arising from right pulmonary artery. All
possibilities occurring under A could occur here.

2. Right-sided upper portion of the descending aorta.

A. Right-sided ductus arteriosus arising from right pulmonary artery.
1. Functioning double aortic arch.
a. Arches of approximarely equal size.
b. One arch narrowed.
2. Double aortic arch with partial artesia of one arch.
3. Left-sided aortic arch with retroesophageal segment and right-sided upper
portion of the descending aorta.
a. Right subclavian artery originating from right-sided aortic
diverticulum.
b. Right subclavian artery originating from innominate artery on right
side.
4. Right-sided aortic arch.
a. Left subclavian artery arising from the distal portion of the aortic arch
or from the descending aorta and passing to the left, usually behind the
esophagus.
b. Left subclavian artery originating from innominate artery on left side
(mirror image of usual pattern).
B. Left-sided ductus arteriosus arising from left pulmonary artery. All possibilities
occurring under A could occur here.
From Kirklin and Clagett.

Brombart and Segers described eleven cases of right aortic arch as an isolated variation, i.e. not associated with congenital heart diseases. The 11 cases were part of a series of 8000 roentgen examinations, in which the esophagus was opacified as an essential requirement for the conclusive diagnosis of right aortic arch. In the majority of cases the variation is symptom free.

The inversion of the aortic arch is caused by the "disturbance" of the embryological formation of the branchial arches; the right aortic arch develops from the 4th right branchial arch rather than the left arch.

There are two principal anatomical varieties;
1). The left subclavian arising as the first major vessel from the aortic arch crosses the anterior wall of the trachea.

2). The left subclavian arising as the last major vessel of the aortic arch crosses the posterior wall of the esophagus. In this variety, the left subclavian artery does not arise directly from the arch but rather from an aortic diverticulum, the source of which being the 4th left branchial arch.

Radiologists divide the right aortic arches into three different types:
1) the right aortic arch without aortic diverticulm (simple).

2) the right aortic arch with a posterior aortic diverticulum (most common of the three).
In types one and two, the descending aorta becomes elongated posteriorly to the right side.

3) The right aortic arch crossing to the left side behind the esophagus and continuing as the descending aorta on the left side. In this type, the orientation of the arching of the descending aorta is the same as in the most common or usual aortic arch.

The right aortic arch is frequently associated with other variations of the azygos vein, ribs or dorsal (thoracic) vertebra.The azygos lobe of the lung is relatively frequent on the right side, and Brombart and Segers have observed a case of right aortic arch associated with a left azygos pulmonary lobe (hemiazygos vein located on the right side).

In some cases, the inverted (right) aortic arch produces a compression of the esophagus, which causes difficulty in swallowing (dysphagia lusoria).

The branches of the thoracic aorta may be divided into visceral and parietal. The parietal branches are the bronchial, esophageal, pericardiac, mediastinal, and an occasional aberrant artery. The parietal branches include the posterior intercostal, subcostal, and the superior phrenic.

Deaver reported on variations of the arch of the aorta found during medical school dissection for the years 1883-1888. Four variations were found during this time. In three of these variations the transverse portion of the arch gave origin to but two vessels, the innominate and left subclavian arteries; the right subclavian, the right and left common carotid arose from the innominate. In the fourth the transverse portion of the arch gave origin to to three vessels, the right and left common carotid arteries and the left subclavian artery; the right subclavian being a branch of the descending portion of the arch and passing behind the trachea.

According to Deaver, Henle recorded the following aortic arch variations: 1) There are two ascending aortas uniting above to form the descending or thoracic aorta; each aorta giving off the subclavian, the external and internal carotid arteries to the corresponding side. 2) The transverse portion of the arch divides into two, including the esophagus and trachea, and uniting to form the descending portion; from the anterior division arises the left common carotid and the left subclavian and from the posterior division the right subclavian, the right common carotid arising from the transverse portion just before it divides. 3) The innominate arises from the ascending portion of the arch, the left common carotid and subclavian from a common trunk close to the innominate. 4) The right subclavian, the right common carotid and left subclavian arise from the transverse portion of the arch, the latter vessel having the ductus arteriosus connected with it; the left common carotid arising from the descending portion. 5) The right and left common carotid, the left and right subclavian arise from the transverse portion of the arch, the right subclavian from the extreme left and passing behind the trachea. 6) The right and left common carotid, the left vertebral and the left subclavian arise from the transverse portion of the arch, the right subclavian from the descending portion and passing behind the ascending aorta. 7) The right and left common carotid and the left subclavian arise from the transverse portion of the arch, the right subclavian arising from the descending aorta and passing under the transverse portion of the arch. 8) The middle thyroid artery is a branch of the transverse portion of the arch.

Right aortic arch has been studied by numerous investigators and a few provide statistics (from Sprong and Cutler):

Bankart, Pye-Smith and Phillips

1 in 158 cadavers.

Barbo

1 in 676 subjects.

Brigham

1 in 1400 cases.

Quain

1 in 1040 individuals.

Aortic Visceral branch: Bronchial.
See also Bronchial Artery

Anson, (1966) describes the bronchial artery variation as follows: "The bronchial arteries are small branches of the aorta and intercostal arteries that supply the main stem and lobar bronchi, contribute to the bronchial and lung tissue peripheral to the hilum. They also supply the midpoint of the esophagus, the tracheobronchial lymph nodes, the vagus nerve in its course near and within the lung, the pulmonary artery, and the visceral pleura of the lung, either directly or by anastomoses with terminal branches of the pulmonary artery. They also form open anastomoses with the pulmonary artery by channels larger than capillaries."

The bronchial arteries are variable in their origin, course, and distribution. Cauldwell, et al. (1948), noted that several patterns of origin occur. "Usually there are three arteries, one on the right and two on the left (48%). A single bronchial artery on each side was found in 25% of subjects, and paired vessels to both sides was found in 14%. When arising from the thoracic aorta, most of the bronchial arteries arise at the fifth and sixth vertebral level."

The right bronchial artery arises (usually) from a common stem with the first aortic intercostal (intercostobronchial artery), from the dorsolateral aspect of the aorta, in 78% of individuals. It may also arise from the second aortic intercostal. The intercostobronchial artery courses either behind the esophagus (67% of subjects) or in front of it (11% of subjects). It then continues cranialward to bifurcate into an appropriate intercostal and a right bronchial artery. The bronchial courses caudally, beneath the arch of the azygos vein, to the right bronchus, where it follows the posterosuperior border of the bronchus to enter the lung.

A right bronchial artery may arise from the aorta independent of an intercostal artery in 30% of individuals. It passes before or behind the esophagus but lies caudal to the arch of the azygos. Its usual path being along the inferior margin of the bronchus upon entering the lung.
A right bronchial artery may arise from a left bronchial artery.
An esophageal branch usually arises from the right bronchial artery.

The left bronchial arteries, as previously mentioned, are two in number. They arise from the ventral surface of the thoracic aorta and pass directly to the dorsal side of the left bronchus and distributes into the lung along the posterior superior and posterior inferior borders of the bronchus. A left bronchial artery arises in common with a right bronchial in 26% of subjects.

Esophageal branches are derived from both left bronchial arteries.

Aortic Visceral Branch: Esophageal
One to three esophageal arteries, most frequently two (90%), usually unpaired arise from the anterior aspect of the aorta, slightly to the right of the midline. The superior artery arises at the disk between the sixth and seventh thoracic vertebra, and the inferior artery arises at the disk between the seventh and eighth thoracic vertebra and is usually the larger and longer of the two esophageal arteries.

Aortic Visceral Branch: Pericardiac
The arteries are usually two or three in number, they are small, and irregular in their origin, course and distribution. They run to the posterior surface of the pericardium and anastomose with other pericardiac branches and sources.

Aortic Visceral Branch: Mediastinal
The mediastinal branches are small but numerous. They distribute to the pleura, vessels, nerves, and lymph nodes of the posterior mediastinum.

Aortic Visceral Branch: Aberrant Artery
This small twig arises from the thoracic aorta near the right intercostobronchial artery. It is occasionally found to anastomose on the esophagus with an aberrant artery of the right subclavian, costocervical, or supreme intercostal artery. It is considered by some investigators as the remnant of the embryologic right dorsal aortic root.

Aortic Parietal Branch: Posterior Intercostal
Esophageal branches arise from the intercostal arteries in about 20% of cases. They are usually found on the right side from the fifth posterior intercostal artery.

Aortic Parietal Branch: Lateral Cutaneous Intercostal
The anterior branches of the lateral cutaneous branches of the intercostal arteries may supply lateral mammary branches to the lateral region of the breast.

Image 11, Image 26, Image 72, Image 88, Image 118, Image 129, Image 164, Image 278, Image 282A, Image 282B,Image 190, Image 394, Image 396, Image 420A, Image 420B, Image 420C, Image 420D

Descending
Image 86

Thoracic
See Images 86, 282A, 282B

Aortic Arch
See Images 11, 26, 72, 87A, 87B, 88, Image 150, Image 156 , 164, 278, 282, 394, 396, 420A, 420B, 420C, 420D, Image 436 Image 505, Image 500

Branches of
See Images 26, 72, 88, 129, 150, Image 159, Image 179, Image 180, Image 181, Image 182, See Image 190, Image 280, Image 281, Image 284, Image 285, See Images 420A, 420B, 420C, 420D

Doubled
Image 115, Image 153, Image 158, Image 222

Retroesophageal
See Image 190, 191, See Image 394, 414, See Images 420A, 420B, 420C, 420D, 425

Right
157, See Images 278, 280, 394, 396, 414, 420A, 420B, 420C, 420D, 425

Ring
See Images 11, 153, 156, 158, 160, 165, 190, 191, 279, 394, 396, 420A, 420B, 420C, 420D

Transposition
440, 441

Arteria Lusoria Dextra (Right)

Image 230, Image 231, See Image 394

Arteria Lusoria Sinistra (Left)

See Image 425


References

Abbott, F.C. (1892) Specimen of right aortic arch. Proceedings of the Anatomical Society of Great Britain and Ireland. J. Anat. Physiol. 26:581-582.

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