The typical branching pattern of the aortic arch was found in 339 patients(66,3%). The most common variant was a common origin of the brachiocephalic and left common carotid artery, seen in 65 patients(12,7%), followed by the left vertebral artery arising directly from the aortic arch in 37 patients(7,2%). According to some authors incidence of another aortic arch variants than the abovementioned is very low.[3][9]          

The higher incidence of aortic arch anomalies in our study is presumably due to selection bias. 126 patients were referred from the cardiology and cardiac surgery departments. In most cases this patients were known to bear aortic arch anomaly and findings of anomalies were not incidental. In this subgroup only 50 patients(39,7%) had normal branching pattern of the aortic arch.

Both open surgical and endovascular procedures have evolved in the last decades. The list of indications for minimally invasive treatments in the region of the head and neck has expanded. In these settings appropriate preprocedural imaging is often mandatory. A thorough knowledge of these variants allows accurate interventional planning and may decrease number of complications, increasing the possibility of good clinical and technical outcome.

In 2017 results of a 10-year follow up of pediatric interventional radiology workforce survey were presented.[10] According to that study pediatric interventional radiology(PIR) services have grown significantly since 2005 and it is believed to grow in the future. We hope that knowledge of aortic arch variants, presented in our study, would especially facilitate PIR practitioners and pediatric surgeons in their daily practice.

To the best of the authors’ knowledge this is the largest study dealing with frequency of aortic arch variants in children. With the tremendous expansion of endovascular techniques in the region of the head and neck, awareness of aortic arch variants in the pediatric population is of utmost importance for physicians dealing with patients of this age group.