BACKGROUND Variations in aortic arch anatomy have been extensively described from multiple perspectives including gross anatomy, embryology, associated cardiac and other anomalies, early life presentation, and cross-sectional diagnosis. There is however a paucity of literature with an emphasis on safe and timely catheterization, particularly when the variants are found during emergent or other catheter angiographic procedures without benefit of prior cross-sectional vascular imaging. The purpose of this review is to try to fill this gap. METHODS A review of past 1,000 diagnostic and therapeutic catheterizations was performed to identify arch variants, which are presented in order of frequency encountered at our institutions. RESULTS The variants are presented as illustrations and catheter angiographic images, with emphasis on safe and efficient intraprocedural diagnosis and catheterization. CONCLUSION Familiarity with more and less common arch variants, along with low threshold for performance of pigtail aortic arch angiography and comfort in use of general purpose and recurved catheters, will ensure success in the vast majority of encountered variations.

中文翻译：

---

主动脉弓变体：安全及时导管插入的实用指南。

背景主动脉弓解剖学的变化已经从多个角度进行了广泛的描述，包括大体解剖学、胚胎学、相关的心脏和其他异常、早期生命表现和横断面诊断。然而，很少有文献强调安全和及时的导管插入术，特别是当在急诊或其他导管血管造影过程中发现变异而没有先前的横断面血管成像的好处时。本次审查的目的是试图填补这一空白。方法 对过去 1,000 次诊断和治疗性导管插入术进行了回顾，以确定弓形变体，这些变体按我们机构遇到的频率顺序排列。结果 变体以插图和导管血管造影图像的形式呈现，强调安全有效的术中诊断和导尿。结论 熟悉越来越多的常见弓形变体，以及猪尾主动脉弓血管造影的低阈值以及使用通用和反曲导管的舒适性，将确保在绝大多数遇到的变体中取得成功。