The aortic arch branching pattern: a 14,632 cases review

Variations of the aortic arch branching pattern have a direct repercussion and influence not only in vascular surgery, but also in otorhinolaryngological and endocrinological surgery of the neck, radiological interpretation and procedures, intensive care unit patients management, mostly those with long-term nasogastric tubes, ischemic brain injuries linked to vascular interventions and during trauma patients diagnosis and management. Most of these variations are asymptomatic and have been largely considered clinically benign. Recent studies have pointed some of these vascular patterns as potential anatomical markers for thoracic aortic disease. The main objective of this work is to determine the prevalence of the aortic branching pattern reviewing a high number of cases, 14,632 (the highest as far as we know) from 38 anatomical and radiological studies, seven cohort studies and one case-control study The second objective is to propose a novel classification which includes most of the aortic arch patterns described until now in literature, and that easily allows to add new patterns that might be described in the future. This classification was used to group the results, based primarily in the number of main arterial branches arising directly from the aortic arch, and subsequently sub-classified according to the arise of secondary arteries from the arch. Pattern IIIA of the proposed classification represents the normal anatomical disposition, and along with its subtypes, determined by secondary arteries arising directly from the arch, they represented 81.87% of the reviewed cases. Pattern II A, commonly known as “bovine arch”, when grouped with its five subtypes, represented 10.87% of the total, becoming the second anatomical variation most frequently found. Frequency of pattern II B and its subtypes was 5.40% in our review. Among secondary arteries arising frequency, 589 cases or 4.03% had a left vertebral artery emerging directly from the arch. The hardest part was to merge the results from the different studies due to the inhomogeneity of their descriptions. We believe that one of the most remarkable aspects of this work is the new classification we have created to describe the results. Since it is based on the anatomical pattern rather than frequency, it easily allows to add new patterns

Aortic arch branching pattern variation: its incidence on a 20.030 cases review.

Aim of the study: the main objective of this work was to study the frequency of variation of the aortic arch branching pattern in a wide and varied population. Introduction: Variations in the branching pattern of the aortic arch are clinically relevant because of the direct influence that their presence can have on the success of cardio-vascular procedures, neck or thorax surgery, in trauma management or in intensive care unit patient’s. In most cases these anatomical variations are asymptomatic and considered clinically benign, but some particular aortic branching patterns had been associated with surgical complications or with vascular diseases in medical non surgical patients. Methods: this paper analyzes the aortic arch branching patterns of 20.030 cases reported by 40 anatomical or radiological studies. Results: 84,52% of the studied population has a three branches pattern and 14,65% has a two branches pattern. The four primary arteries arising directly from the aortic arch were seen in 0,81% of the cases and only 0,02% had them all arising from a common trunk

Aortic arch branching pattern variation: its incidence on a 20030 cases review

Variations in the branching pattern of the aortic arch are clinically relevant because of the direct influence that their presence can have on the success of cardio-vascular procedures, neck or thorax surgery, trauma management or intensive care. In most cases these anatomical variations are asymptomatic and considered clinically benign, but some particular aortic branching patterns have been associated with surgical complications or with vascular diseases in non-surgical patients. The main objective of this work was to study the frequency of variation of the aortic arch branching pattern in a wide and varied population on the basis of literature reports. The aortic arch branching pattern of 20,030 cases reported by 40 anatomical or radiological studies were analyzed. 84,52% of the studied population had a three branches pattern and 14,65% had a two branches pattern. The four primary arteries were seen arising directly from the aortic arch in 0,81% of the cases and only 0,02% had them all arising from a common trunk

Effect of Cholinesterase Inhibitors on Mortality in Patients With Dementia: A Systematic Review of Randomized and Nonrandomized Trials

International audienceBackground and objectives: Cholinesterase inhibitors (ChEIs) have cardiovascular effects in addition to their neurological activity and might alter mortality. We wanted to know if treatment with ChEIs modifies mortality in patients with dementia. Methods: We searched PubMed, EMBASE, Cochrane CENTRAL, ClinicalTrials.gov and ICRTP, from their inception to November 2021, and screened bibliographies of reviews, guidelines and included studies. We included randomized controlled trials (RCTs) and non-randomized controlled studies at lower risk of bias comparing ChEI treatment with placebo or usual treatment, for 6 months or longer, in patients with dementia of any type. Two investigators independently assessed studies for inclusion, assessed their risk of bias and extracted data, using predefined forms. Any discordance between investigators was solved by discussion and consensus. Data on all-cause and cardiovascular mortality, measured as either crude death rates or multivariate adjusted hazard ratios (HR), was pooled using a random-effect model. Information size achieved was assessed using trial sequential analysis (TSA). We followed PRISMA guidelines. Results: 24 studies (12 RCTs, 12 cohorts, mean follow-up 6 to 120 months), cumulating 79 153 patients with Alzheimer’s (13 studies), Parkinson’s (1), vascular (1) or any type (9) dementia, fulfilled inclusion criteria. Pooled all-cause mortality in control patients was 15.1 per 100 person-years. Treatment with ChEIs was associated with lower all-cause mortality (unadjusted RR 0.74, 95%CI 0.66 – 0.84; adjusted HR 0.77, 95%CI 0.70 – 0.84, moderate to high quality evidence). This result was consistent between randomized and non-randomized studies and in several sensitivity analyses. No difference appeared between subgroups by type of dementia, age, individual drug or dementia severity. Less data was available for cardiovascular mortality (3 RCTs, 2 cohorts, 9 182 patients, low to moderate quality evidence), which was also lower in patients treated with ChEIs (unadjusted RR 0.61, 95%CI 0.40 – 0.93, adjusted HR 0.47, 95%CI 0.32 – 0.68). In TSA analysis, results for all-cause mortality were conclusive, but not those for cardiovascular mortality. Discussion: There is moderate to high quality evidence of a consistent association between long-term treatment with ChEIs and a reduction in all-cause mortality in patients with dementia. These findings may influence decisions to prescribe ChEIs in those patients. Trial Registration Information: This systematic review was registered in the PROSPERO international prospective register of systematic reviews with the number CRD42021254458 (11/06/2021)