[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Chest](https://durgical.com/en/anatomy/region/chest/) › Aortic arch [Cardiovascular system](https://durgical.com/en/anatomy/system/cardiovascular-system/) · [Chest](https://durgical.com/en/anatomy/region/chest/) # Aortic arch The aortic arch is the curve of the aorta in the upper [chest](https://durgical.com/en/anatomy/region/chest/); it sends branches to the head and arms, then turns down as the descending aorta. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=thorax&select=aortic_arch&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The curved top of the aorta, arching back over the left lung root. It gives off the brachiocephalic trunk and the left carotid and subclavian arteries. ## What it does Sends blood to the head and arms, then continues down as the descending aorta. ## Key points - Begins and ends at the sternal angle plane (T4–T5) and lies wholly in the superior mediastinum, behind the lower half of the [manubrium](https://durgical.com/en/anatomy/manubrium-of-sternum/) - Branches from right to left: [brachiocephalic trunk](https://durgical.com/en/anatomy/brachiocephalic-trunk/), left [common carotid artery](https://durgical.com/en/anatomy/common-carotid-artery/), left [subclavian artery](https://durgical.com/en/anatomy/right-subclavian-artery/) - The left recurrent laryngeal nerve hooks under it at the ligamentum arteriosum, so an arch aneurysm can cause hoarseness ## Key facts **Origin** Continues [ascending aorta](https://durgical.com/en/anatomy/ascending-aorta/) at sternal angle; arches back and left over left main bronchus and pulmonary bifurcation **Branches** Brachiocephalic trunk; left common carotid; left subclavian (varies: common origin of first two) **Supplies** Head, neck and upper limbs; becomes descending [thoracic aorta](https://durgical.com/en/anatomy/thoracic-aorta/) at T4–T5 level ## Relations **Course** Runs up, back and to the left from behind the right 2nd sternocostal joint, in front of and then to the left of the [trachea](https://durgical.com/en/anatomy/trachea/), arches over the left main bronchus and pulmonary bifurcation, and descends on the left side of T4 as the descending aorta **Lateral** On its left: the left phrenic and left vagus nerves descending across it, with the left superior intercostal vein passing forward between them; then the mediastinal [pleura](https://durgical.com/en/anatomy/pleura/) and left lung **Medial** On its right and behind: the trachea, the [esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/), the left [recurrent laryngeal nerve](https://durgical.com/en/anatomy/recurrent-laryngeal-nerve/), the [thoracic duct](https://durgical.com/en/anatomy/thoracic-duct/) and the deep cardiac plexus **Above** Its three branches, crossed in front by the left [brachiocephalic vein](https://durgical.com/en/anatomy/brachiocephalic-vein/); the thymic remnant **Below** Pulmonary bifurcation, [ligamentum arteriosum](https://durgical.com/en/anatomy/ligamentum-arteriosum/), left recurrent laryngeal nerve, superficial cardiac plexus and left main bronchus ## How to find it Not palpable. Its surface line runs from the right 2nd [costal cartilage](https://durgical.com/en/anatomy/costal-cartilage/) up to a summit behind the mid-manubrium, about 2–2.5 cm below the jugular notch (higher in children and older people), then back and to the left. On a frontal chest X-ray its distal part forms the aortic knob at the upper left mediastinal border; a large arch aneurysm may pulse in the suprasternal notch. ## On imaging Frontal chest X-ray: the aortic knob at the upper left mediastinal border; after chest trauma a widened mediastinum with a blurred knob raises concern for aortic injury. CT angiography maps aneurysm, dissection, injury and branch variants; on catheter angiography a left anterior oblique view opens the arch. ## Common problems - Aneurysm: the wall weakens and widens, usually silently; it can tear (aortic dissection), an emergency with sudden tearing chest pain. ## How it is diagnosed Echocardiogram, CT or MRI. ## Treatment - Blood-pressure control and monitoring; surgical replacement with a graft when it gets too wide. ## Clinical notes - Deceleration injury tears the aorta at the isthmus, just beyond the left subclavian artery, where the ligamentum arteriosum tethers it - An arch aneurysm can press on the left recurrent laryngeal nerve (hoarseness), the trachea (stridor, tracheal tug) or the esophagus (dysphagia) - Coarctation usually sits at the isthmus near the ligamentum arteriosum: weak, delayed femoral pulses, [upper limb](https://durgical.com/en/anatomy/region/upper-limb/) hypertension and rib notching from enlarged intercostal collaterals - A dissection beginning beyond the left subclavian artery is Stanford type B; if the ascending aorta is involved it is type A, whatever the arch does ## Anatomical variants - Common origin of the brachiocephalic trunk and left common carotid artery (often called a bovine arch), the most frequent variant - Left [vertebral artery](https://durgical.com/en/anatomy/vertebral-artery/) arising directly from the arch, between the left common carotid and left subclavian arteries - Aberrant right subclavian artery as the last branch, passing behind the esophagus; it can cause dysphagia lusoria and comes with a non-recurrent right laryngeal nerve - Right-sided or double aortic arch; a double arch forms a vascular ring around the trachea and esophagus ## Development The proximal arch comes from the aortic sac, the segment between the left common carotid and left subclavian arteries from the left 4th pharyngeal arch artery, and the distal part from the left dorsal aorta. ## Memory aid ABC'S: the aortic arch gives the brachiocephalic trunk, the left common Carotid and the left Subclavian, in that order. ## Related conditions - [Hypertensive emergency and urgency](https://durgical.com/en/conditions/hypertensive-emergency-and-urgency/) - [Turner syndrome](https://durgical.com/en/conditions/turner-syndrome/) - [DiGeorge syndrome (22q11.2 deletion syndrome)](https://durgical.com/en/conditions/digeorge-syndrome/) - [Takayasu arteritis](https://durgical.com/en/conditions/takayasu-arteritis/) - [Thoracic aortic aneurysm and aortitis](https://durgical.com/en/conditions/thoracic-aortic-aneurysm-and-aortitis/) - [Patent ductus arteriosus](https://durgical.com/en/conditions/patent-ductus-arteriosus/) - [Coarctation of the aorta](https://durgical.com/en/conditions/coarctation-of-the-aorta/) ## Test yourself Think of the answer, then tap the question to see it. ## What are the branches of the aortic arch from right to left? The brachiocephalic trunk, the left common carotid artery and the left subclavian artery. ## Why can an aneurysm of the aortic arch cause hoarseness? The left recurrent laryngeal nerve hooks under the arch at the ligamentum arteriosum, so the aneurysm can press on it. ## Where does a deceleration injury typically tear the aortic arch region? At the isthmus, just beyond the left subclavian artery, where the ligamentum arteriosum tethers the aorta. ## Where does coarctation of the aorta usually sit, and what are its classic signs? At the isthmus near the ligamentum arteriosum: weak, delayed femoral pulses, upper limb hypertension and rib notching from enlarged intercostal collaterals. ## At which vertebral level does the aortic arch begin and end? At the sternal angle plane (T4–T5); the whole arch lies in the superior mediastinum, behind the lower half of the manubrium. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/anatomy/aortic-arch/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** arcus aortae TA2 4177 **Official Spanish (DeCS)** Arco de la aorta DeCS D001011 **English (TA2)** Aortic arch **Also called** arch of aorta ## Related - [Recurrent laryngeal nerves](https://durgical.com/en/anatomy/recurrent-laryngeal-nerve/) - [Ligamentum arteriosum](https://durgical.com/en/anatomy/ligamentum-arteriosum/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=1016); [Anatomy, Thorax, Heart Great Vessels](https://www.ncbi.nlm.nih.gov/books/NBK547680/); [Anatomy, Thorax, Mediastinum Superior and Great Vessels](https://www.ncbi.nlm.nih.gov/books/NBK519576/); Anatomy of the Human Body (20th ed.): Surface Markings of the Thorax (Lea & Febiger (Gray's Anatomy, 1918), 1918) · adapted, Public domain; Tratado de anatomía humana (9.ª ed.), tomo II, Libro IV, sección 2 Arterias, caps. I-III (sistema de la arteria pulmonar; aorta y ramas del cayado hasta la carótida interna). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/aortic-arch/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/aortic-arch/