VESS Clinical ResearchPrevalence of Bovine Aortic Arch Configuration in Adult Patients with and without Thoracic Aortic Pathology
Introduction
The standard and most common aortic arch branching pattern contains separate origins of the 3 great vessels, the innominate, left common carotid, and left subclavian arteries. The term bovine aortic arch (BA) refers to a group of known congenital variants of human aortic arch vessels, in which there is aberrant origin of the left common carotid artery (Fig. 1). The most common of these variants, a type I bovine arch (T1BA), has a common origin of the innominate and left common carotid arteries at the level of the aortic arch. A type II bovine arch (T2BA) in which the left common carotid artery originates directly from the innominate artery at an average distance of <1 cm and not greater than 2.5 cm from the aorta is slightly less common.1 The prevalence of bovine arches seen on imaging has been reported to range from 15% to 35% of the US population.1, 2, 3, 4 Bovine arches are more prevalent in the African American population than among Caucasians.1, 4 Other arch vessel branching patterns exist, however, bovine arches are far more common, comprising 97% of anatomic variation observed.5
Bovine arch is traditionally viewed as a “normal”, clinically benign variant6; however, a higher incidence of neurologic events has been reported during endovascular procedures in these patients.7 This may require alteration in the approach or technique during cerebrovascular procedures.8, 9, 10 At this institution, anecdotal observation of a number of patients with acute aortic dissection and aneurysm in the setting of BA was the impetus for this study. There have been recent case reports and small studies suggesting a possible association between thoracic aortic pathologies (i.e., aneurysms and dissections) and bovine arch configuration6, 11, 12; however, none of these studies have examined disease prevalence among the subtypes of bovine arch.
The purpose of this study was to evaluate the prevalence of bovine arch subtypes and characterize their association with thoracic aortopathy. We hypothesized that there is an association between nonstandard arch configuration and thoracic aortic pathology.
Section snippets
Study Design
We retrospectively reviewed computed tomography (CT) images of the chest performed at a single tertiary institution. Included images visualized the complete thoracic aorta (TAA) and branching arch vessels. CT reports were generated by board-certified radiologists. Indications for imaging included assessment for thoracic aortic disease, trauma, postoperative complication, pulmonary embolism, pulmonary infection, malignancy, and others. Patients with congenital heart defects, such as bicuspid
Prevalence of Bovine Aortic Arch in the General Population
In a 4-month period, CT scans were performed on 817 patients. Approximately, 47% of our population was Caucasian and 50% was African American. This is consistent with the census profile of the counties served by this institution. There were slightly more females than males (58.2% vs. 43.2%). Nearly, all patients resided within the state of Ohio (98.5%; Table II).
Analysis of the 817 patients from the original query revealed that the overall prevalence of bovine aortic arch variants in our study
Discussion
We found the overall prevalence of bovine arch from our initial 4-month sample to be 31.1%. This is consistent with the most recently published literature given the racial profile of our patients. Layton et al.1 reported a bovine arch population prevalence of 22%, occurring in 13% of Caucasians and 35% of African Americans. They noted a higher prevalence of T1BA than T2BA (13% vs. 9% of the total population, respectively). More recently, Ahn et al.4 reported a higher prevalence of bovine arch
Conclusions
Our analysis revealed a prevalence of bovine arch of 31.1%, consistent with the demographics of our patient population. T2BA or “true bovine arch” occurred more frequently in patients with thoracic aortic dilations than those without pathology. A nonsignificant trend existed toward higher prevalence of BA among dissection patients. Therefore, bovine aortic arch anomalies may be associated with increased rates of thoracic aortic pathology. “Thus, bovine arch may prove to be a risk factor for
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