Changes in the Relative Displacement between the Supra-Aortic Branches with Age


      This study aimed to determine the normal ranges for the height and deflection angle of the aortic arch and the displacement distances between the supra-aortic branches in relation to age, sex, body mass index (BMI), and body surface area (BSA) in adults without aortic disease using non–contrast chest computed tomography (CT).


      The CT scans of 700 patients were analyzed. We measured the height and deflection angle of the aortic arch based on the lower level of the pulmonary artery bifurcation. The displacement distances between the supra-aortic branches in the coronal and sagittal planes were measured, and the deflection angles between these branches were calculated. Multiple linear regression analysis was used to investigate the associations of age, sex, BMI, and BSA with these aortic arch parameters.


      The height of the aortic arch was significantly higher (74 ± 15 mm vs. 65 ± 12 mm, P < 0.001) and the left-posterior displacement distance of the left subclavian artery (LSA) to the innominate artery (IA) was greater in men than that in women. The height and deflection angle of the aortic arch increased with age. The distance by which the LSA was shifted to the left posterior of the left common carotid artery and to the left of the IA increased with age.


      The normal aging process is accompanied by morphological changes in the aortic arch and relative displacement between the supra-aortic branches. Identifying these parameters could lead to a comprehensive understanding of the anatomy and morphology of the aortic arch.
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        • Czerny M.
        • Schmidli J.
        • Adler S.
        • et al.
        Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS).
        Eur J Cardiothorac Surg. 2019; 55: 133-162
        • Wolak A.
        • Gransar H.
        • Thomson L.E.
        • et al.
        Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area.
        JACC Cardiovasc Imaging. 2008; 1: 200-209
        • Li S.
        • Zhuang B.
        • Yin G.
        • et al.
        Reference values of thoracic aorta and pulmonary artery diameters by age and gender in healthy Chinese adults assessed by cardiac magnetic resonance imaging: data from national center for cardiovascular diseases of China.
        Int J Cardiovasc Imaging. 2021; 37: 1423-1431
        • Adriaans B.P.
        • Heuts S.
        • Gerretsen S.
        • et al.
        Aortic elongation part i: the normal aortic ageing process.
        Heart. 2018; 104: 1772-1777
        • d'ostrevy N.
        • Ardellier F.D.
        • Cassagnes L.
        • et al.
        The apex of the aortic arch backshifts with aging.
        Surg Radiol Anat. 2017; 39: 703-710
        • Mosteller R.D.
        Simplified calculation of body-surface area.
        N Engl J Med. 1987; 317: 1098
        • Casciaro M.E.
        • Craiem D.
        • Chironi G.
        • et al.
        Identifying the principal modes of variation in human thoracic aorta morphology.
        J Thorac Imaging. 2014; 29: 224-232
        • Alhafez B.A.
        • Truong V.T.T.
        • Ocazionez D.
        • et al.
        Aortic arch tortuosity, a novel biomarker for thoracic aortic disease, is increased in adults with bicuspid aortic valve.
        Int J Cardiol. 2019; 284: 84-89
        • Sugawara J.
        • Hayashi K.
        • Yokoi T.
        • et al.
        Age-associated elongation of the ascending aorta in adults.
        JACC Cardiovasc Imaging. 2008; 1: 739-748
        • Rylski B.
        • Desjardins B.
        • Moser W.
        • et al.
        Gender-related changes in aortic geometry throughout life.
        Eur J Cardiothorac Surg. 2014; 45: 805-811