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The aortic arch, arch of the aorta, or transverse aortic arch ( OED 2nd edition, 1989, as . Entry "aortic" in Merriam-Webster Online Dictionary.) is the part of the aorta between the ascending aorta and descending aorta. The arch travels backward, so that it ultimately runs to the left of the trachea.
The aortic arch has three main branches on its superior aspect. The first, and largest, branch of the arch of the aorta is the brachiocephalic trunk, which is to the right and slightly anterior to the other two branches and originates behind the manubrium of the sternum. Next, the left common carotid artery originates from the aortic arch to the left of the brachiocephalic trunk, then ascends along the left side of the trachea and through the superior mediastinum. Finally, the left subclavian artery comes off of the aortic arch to the left of the left common carotid artery and ascends, with the left common carotid, through the superior mediastinum and along the left side of the trachea. An anatomical variation is that the left vertebral artery can arise from the aortic arch instead of the left subclavian artery.
The arch of the aorta forms two curvatures: one with its convexity upward, the other with its convexity forward and to the left. Its upper border is usually about 2.5 cm below the superior border to the manubrium sterni. (2025). 9788180617348, Jaypee Bros. Medical Publishers. ISBN 9788180617348 Blood flows from the upper curvature to the upper regions of the body, located above the heart - namely the arms, neck, and head.
Coming out of the heart, the thoracic aorta has a maximum diameter of 40 mm at the root. By the time it becomes the ascending aorta, the diameter should be <35–38 mm, and 30 mm at the arch. The diameter of the descending aorta should not exceed 25 mm.
The arch of the aorta lies within the mediastinum.
At the cellular level, the aorta and the aortic arch are composed of three layers: The tunica intima, which surrounds the lumen and is composed of simple squamal epithelial cells; the tunica media, composed of smooth cell muscles and elastic fibers; and, the Tunica externa, composed of loose collagen fibers. Innervated by baroreceptors nerve terminals, the aortic arch is responsible for sensing changes in the dilation of the vascular walls, inducing changes in heart rate to compensate for changes in blood pressure.
The ductus arteriosus connects to the lower part of the arch in foetal life. This allows blood from the right ventricle to mostly bypass the pulmonary vessels as they develop.
The final section of the aortic arch is known as the aortic isthmus. This is so called because it is a narrowing (isthmus) of the aorta as a result of decreased blood flow when in foetal life. As the left ventricle of the heart increases in size throughout life, the narrowing eventually dilates to become a normal size. If this does not occur, this can result in coarctation of the aorta. (2025). 9780781795166, Wolters Kluwer/Lippincott Williams & Wilkins. ISBN 9780781795166 (2025). 9780781757652, Wolters Kluwer/Lippincott Williams & Wilkins. ISBN 9780781757652 The ductus arteriosus connects to the final section of the arch in foetal life. Ductus arteriosus then regresses to become ligamentum arteriosum during later life.
Aortopexy is a surgical procedure in which the aortic arch is fixed to the sternum in order to keep the trachea open.
Aortic isthmus is the relatively fixed part of the aortic arch. It is prone to shearing force and trauma that can cause it to Aortic rupture and result in massive bleeding.
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