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An introduction is presented in which the editor discusses the guidelines issued by the European Association for Cardio-Thoracic Surgery (EACTS) for myocardial revascularization, for the treatment of aortic arch and lung surgeries.

Preventing the occurrence and recurrence of stroke is the top priority of the treatment strategy for ischemic cerebrovascular disease. Patients with multiple cerebral vascular stenosis and aortic arch ulcer plaques have a significantly increased risk of recurrent ischemic stroke. This paper introduces a case of probucol combined with atorvastatin in the treatment of multiple cerebral vascular stenosis with aortic arch ulcer plaque. This acute ischemic stroke patient presented with mild neurological impairment. During his hospitalization, multiple cerebral vascular stenosis and aortic arch ulcer plaques were discovered. After 3 months of sequential dual antiplatelet therapy, aspirin therapy was continued and combined with probucol and atorvastatin throughout the course for enhanced lipid-lowering antioxidant therapy. After 25 months of follow-up, there was no recurrence of stroke in this patient, and all imaging and hematological indicators remained stable. [ABSTRACT FROM AUTHOR]

Background: The investigation on the cardiocirculatory system in chinchilla has become increasingly important due to the use of the species in experimental medicine (toxicology, pathology, parasitology etc.). Even though initially this species was regarded with a strict economic interest, in the last period, chinchillas have become an increasingly-encountered patient in veterinary clinics and hospitals. Another aspect is the use of the species in medical research, as experimental model or in parasitology. The present study tackles a combined anatomical and radiological (angiographical) study to accurately describe the vascular anatomy of the initial part of the aortic arch (Arcus aortae). Materials, Methods & Results: The anatomical distribution of collaterals detached from arcus aorticus (brachiocephalic trunk and subclavian arteries) are highlighted in this paper. To do that, the classical stratigraphic anatomical investigation, followed by the radiological study with the help of the contrast substance injected into the vascular bed were used in combination. Several Chinchilla lanigera female carcasses, obtained from a private commercial farming unit in Cluj county, Romania were used for this study. Ten carcasses were used for the anatomical study, being injected into the vascular bed with a mixture of latex and acrylic dye, fixated into formaldehyde 5% and later dissected, while the other ten carcasses were injected at the level of the aortic arch with Visipaque 320 contrast substance and subjected to the angiographical procedure. The anatomical investigation was carried after an initial 5 day-fixation period, while the angiographic procedure was initiated using the TEMCO Grx-01 device and the Veterinary Digital Imaging System® as digital imaging processing software. This combined study shows the differential mode of emergence of the subclavian and carotid arteries in this species. The brachiocephalic trunk is the first large collateral branch arising from the initial part of the aortic cross while the left subclavian artery, in all studied cases, stems from this initial part of the aortic arch. The right subclavian artery arises from the terminal part of the brachiocephalic trunk, at the cranial border of the first rib. The continuation of the trunk is represented by right common carotid artery that follows the right jugular groove. The left common carotid artery emerges at the medial aspect of the first intercostal space as a collateral branch detached from the brachiocephalic trunk, in its initial sector. In respect to the collaterals emerging from the subclavian arteries, our study showed that in all studied cases, four branches arise in sequence- the internal thoracic, dorsal scapular, vertebral and superficial cervical arteries. The existence of the common trunks (internal thoracic, dorsal scapular arteries and superficial and deep cervical arteries (as described by other authors) was not confirmed on the investigated specimens. Discussion: The paper highlights some interesting facts referring to the specific morphology of the aortic arch in chinchilla, as literature data provides some divergent data. Some of the aspects noted are confirmed (the emergence of subclavian arteries) while some others are still subjects to discussion and further investigation (collateral branches of subclavian arteries). Our approach focuses also on the comparative aspects of the morphology of the branches emerging from the aortic arch. According to the available literature, the following species were used as comparison: leporids, Guinea pig, squirrel, yellow-necked mouse, Egyptian mouse, rat, armadillo, nutria, capybara, paca, fox and leopard. [ABSTRACT FROM AUTHOR]

Several congenital anomalies regarding the right (RVA) and left (LVA) vertebral artery have been described. The current paper aims to perform a systematic literature review of the variable vertebral artery (VA) origin from the aortic arch (AOA) and its branches. The incidence of these variants and the ensuing AOA branching pattern are highlighted. Atypical origin cases were found more commonly unilaterally, while LVA presented the majority of the aberrancies. The LVA emersion from the AOA (3.6%) and the RVA from the right common carotid artery (RCCA) (0.14%) were the commonest origin variations. Aberrant RVA origin as last branch of the AOA is very rare. Eighteen cases (0.12%) with an aberrant right subclavian artery (ARSCA) were found. Among them, the RVA originated from the RCCA and right subclavian artery in 94.4 and 5.6%, respectively. Sporadic cases had an AOA origin bilaterally; RVA and LVA had a double origin in 0.027 and 0.11%, respectively. A dual origin was detected in 0.0069%, bilaterally. The atypical VA origin may coexist with: (i) an ARSCA, (ii) a common origin of brachiocephalic artery and left common carotid artery (the misnomer bovine arch) and (iii) a bicarotid trunk. The aberrant VA origin favors hemodynamic alterations, predisposing to cerebrovascular disorders and intracranial aneurysm formation. Detailed information of VA variants is crucial for both endovascular interventionists and diagnostic radiologists involved in the treatment of patients with cerebrovascular disease. Such information may prove useful to minimize the risk of VA injury in several procedures. [ABSTRACT FROM AUTHOR]

Background: Aortic dissection (AD) represents a clinically uncommon aortic pathology which predicts a dismal prognosis if not promptly treated. In acute Debakey type I AD (ADIAD), aortic lesion extends from aortic root to even distal abdominal aorta among which aortic arch and its three main branches still remain a great surgical challenge for repair and reconstruction. Several decades have witnessed the painstaking efforts of cardiovascular surgeons across the globe for optimizing the surgical procedures, from total or hemi-arch replacement, "elephant trunk" technique to branched stent graft. However, operative mortality and morbidity still remain to be reduced and surgical strategy is to be advanced and simplified, particularly the repair and reconstruction of aortic arch and supra-aortic vessels.Methods: In this paper, we reviewed the relevant literature concerning recent advances in surgical intervention of aortic arch and summarized our opinions in the application of branched stent graft in ADIAD.Results: The operative strategy for acute Debakey type I aortic dissection still remain to be advanced and simplified, especially the repair and reconstruction of aortic arch and supra-aortic vessels. For selection of branched stent grafts, the anatomic features and pathological changes of diseased arch are the crucial factors for clinical decision making.Conclusions: Branched stent graft is potentially an effective alternative for the treatment of type I AD with diseased aortic arch and supra-aortic vessels. The selection of branched stent grafts still remains to be further discussed in large-scale studies in the future. [ABSTRACT FROM AUTHOR]

The branches of the aortic arch, according to the classic anatomical description are represented by the brachiocephalic trunk (BCT) being the largest of the vessels, left common carotid artery (LCC) and left subclavian artery (LS). The origin of the LCC artery is more to the left, close to the origin of the LS. However this configuration is only present in 80% of the cases, variations in the disposition of the 3 "classic" branches or the number of arteries arising from the arch can occur. The aortic arch and the branches that arise from it are subject to numerous variations; depending on the type of anatomical variation there can be no detrimental effects present for the subject, or hemodynamic consequences can appear due to a vicious formation. There are many authors treating this subject and numerous anomalies and variation in the disposition of the branches from the aortic arch are reported at different rates of incidence. In the past, a key role in uncovering anatomical anomalies and variants was through dissection, but nowadays these discoveries are made during complementary medical examinations. This paper presents the anatomical variants encountered during a study of 81 aortic arches from fresh specimens. [ABSTRACT FROM AUTHOR]

Variations in the anatomy of the branches of the aortic arch (AA) are well known. But in ordinary surgical practice, being asymptomatic, most of these anatomical variations remain unrecognized. As vascular pathologies proceed affecting the innominate artery (IA) and/or its branches, including the left common carotid artery (CCA) and subclavian artery (SA) — they are noticed and detected. In our paper, two cases of the origin of left CCA from IA are presented. [ABSTRACT FROM AUTHOR]

The article comments on the paper titled "Valve-sparing replacement of the ascending aorta and aortic arch in a child with Loeys-Dietz syndrome" by C. Vuran and colleagues in the 2012 issue.