2 nd International Meeting on Aortic Diseases Liege, Belgium September, 2010
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1 Bovine Aortic Arch Not a Benign Variant 2 nd International Meeting on Aortic Diseases Liege, Belgium September, 2010 John A. Elefteriades, MD William W.L. Glenn Professor and Chief, Section of Cardiac Surgery Yale University School of Medicine
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3 Aneurysms Largely Asymptomatic Vast majority of patients with TAA (90-95%) have no sx until rupture/dissection occur. 1,2 First symptom is usually death from rupture or dissection. Urgent need for screening tests. 1. Barrat-Boyes BG. Lancet 1957: Elefteriades JA et al. Diseases of the Aorta. Hurst s The Heart. McGraw-Hill. New York
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5 Bovine Arch Anatomy Common origin of innominate artery and left common carotid artery (most common) 1 Left common carotid artery originates from innominate artery at distance from aorta (less common) 1 * Note that bovine arch is a misnomer the cow s aorta does not resemble either of these configurations Lippert H, Pabst R. Arterial Variations in Man: Classification and Frequency. München: J.F. Bergmann Verlag, Layton KF, Kallmes DF, Cloft HJ, Lindell EP, Cox VS. Bovine aortic arch variant in humans: clarification of a common misnomer. AJNR Am J Neuroradiol 2006;27:
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7 Study Aims Bovine arch traditionally viewed as normal, clinically insignificant variant We have noted in OR that bovine arch is common in patients with thoracic aortic aneurysm (TAA) We wish to better define any association between bovine arch and thoracic aortic disease
8 Patient Population Disease group: 383 pts w/ known TAA and thoracic CT or MRI scan on record Control group: 350 pts without aortic disease, randomly selected from all patients who underwent thoracic CT scan at YNHH
9 Methods Retrospective review of CT/MRI for presence of bovine arch Review of imaging reports for citation of bovine arch by original radiologist Disease group: asses TAA diameter presence of bicuspid aortic valve clinical outcomes (dissection, rupture, repair)
10 Bovine Arch on Thoracic Imaging
11 Bovine Arch on Thoracic Imaging
12 Results: Incidence of Bovine Arch Variable TA Disease Control P value Group Group Total number Total BA+ (%) 99 (25.8%) 31 (8.9%) <0.001 Imaging reports (radiologists) cited bovine arch in only 11 of 99 (11%) of patients deemed BA+ by our group Incidence of bovine arch significantly greater in patients with thoracic aortic disease than in patients without disease
13 Incidence of BA in Thoracic Aortic Disease and Control Groups
14 Bovine Arch and TAA Growth Rate (cm/year) Variable All Yale patients 3 BA- (n=107) BA+ (n=40) P value (BA- vs. BA+) All Thoracic Aortic Disease Chronic Dissection No Dissection Ascending/Arch Descending TAAs grow significantly faster in patients with bovine arch than in patients without bovine arch 3. Coady MA, Rizzo JA, Elefteriades JA. Developing surgical intervention criteria for thoracic aortic aneurysms. Cardiol Clin 1999;17:
15 BA not significantly associated with: Thoracic aortic dissection Location of thoracic aortic disease (ascending, arch, descending) Age at discovery of thoracic aortic disease Bicuspid aortic valve Gender
16 Conclusions 1) Radiology reports often overlook bovine arch. 2) Bovine aortic arch is significantly more common in patients with TAA than in the general population. 3) Aortas in bovine arch patients grow faster than general TAAs. 4) These observations argue strongly that bovine arch should not be considered a normal variant of aortic arch anatomy.
17 Recommendations 1) Radiologists must consistently look for and report bovine arch anatomy on thoracic scans. 2) Since bovine arch is a misnomer, we propose the name common origin aortic arch to describe this group of anatomic variants. 3) Patients with bovine arch should be followed for TAA.
18 Bovine arch anatomy on a routine CT scan can help us identify hidden patients with TAA.
Non-Size Indications for Aortic Replacement
Blood Test for Thoracic Aortic Aneurysm 2 nd International Meeting on Aortic Diseases September 30-October 2, 2010 Liege, Belgium John A. Elefteriades, MD William W.L. Glenn Professor of Cardiothoracic
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