Bovine Arch – A Marker for Thoracic Aortic Aneurysm Remo Moomiaie, MD a, Matthew Hornick, BA a, Hamid Mojibian, MD b, Esther S. Lee, BA b, Maryann Tranquilli,

Slides:

Advertisements

Similar presentations

Angioclub Case Series: Aortic Pathology Candace L. White MA, MD Mount Sinai Medical Center of Florida.

Advertisements

S L I D E 0 Intracranial Aneurysm Patients May Harbor Thoracic Aortic Aneurysms 1 Yale University School of Medicine, New Haven, CT 2 Department of Neurosurgery,

S L I D E 0 Effect of statin therapy on the natural history of thoracic aortic aneurysms. Louis H. Stein, Jessica Berger, Maryann Tranquilli, John A. Elefteriades.

Long-term Follow-up of Aortic Intramural Hematomas and Penetrating Ulcers Alan S. Chou, BA, Bulat A. Ziganshin, MD, Paris Charilaou, MD, Maryann Tranquilli,

New York Aortic Surgery Symposium 2010 Mohamad Bashir, Aaron Ranasinghe, David Quin, Ben Holloway, Jorge Mascaro, Robert Bonser The limited potential for.

Cardiac Case 9/15/07. Coarctation of the Aorta Congenital narrowing of the thoracic aorta; typically distal to the left subclavian artery. M:F – 2:1.

LAUREN SINNENBERG BS, WILSON SZETO, MD, PATRICK MOELLER BS, PRASHANTH VALLABHAJOSYULA, MD, G. WILLIAM MOSER, CRNP, NIMESH DESAI, MD PHD, JOSEPH BAVARIA,

Aneurysms of the innominate artery: surgical treatment of 27 patients. John D. Symbas, M.D., Michael E. Joseph B. Whitehead Department of Surgery, Division.

15 year old girl with suspicion of Aortic Isthmus Stenosis The girl has no symptoms of cardiac, esophageal or respiratory disease M Romanens,

Brain and spinal cord protection during simultaneous aortic arch and thoracoabdominal aneurysm repair Gottfried Mommertz, MD, Stephan Langer, MD, Thomas.

Management of Abdominal Aortic Aneurysms

Long-term behavior of aortic intramural hematomas and penetrating ulcers Alan S. Chou, BA, Bulat A. Ziganshin, MD, Paris Charilaou, MD, Maryann Tranquilli,

Prospective Study of the Natural History of Thoracic Aortic Aneurysms

In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke Julia Dumfarth, MD, PhD, Sven Peterss, MD, Markus Kofler,

Bulat A. Ziganshin, MD, Allison E

Ourania Preventza, MD, James J. Livesay, MD, Denton A

Julia Dumfarth, MD, Alan S. Chou, BA, Bulat A

Surgical strategy for Kommerell's diverticulum: Total arch replacement

Aortic disease: The quest to improve patient outcomes

The aortic wall: Four questions and insights

When to Operate on the Bicuspid Valve Patient With a Modestly Dilated Ascending Aorta Christian D. Etz, MD, PhD, Stefano Zoli, MD, Robert Brenner, MS,

Tracheal compression caused by an innominate artery aneurysm after thoracic aortic aneurysm repair in a patient with Marfan disease P.W. de Feiter, MD,

Midterm Change of Descending Aortic False Lumen After Repair of Acute Type I Dissection Kay-Hyun Park, MD, PhD, Cheong Lim, MD, PhD, Jin Ho Choi, MD,

Indications for aortic replacement

Surgical intervention criteria for thoracic aortic aneurysms: a study of growth rates and complications Michael A Coady, MD, John A Rizzo, PhD, Graeme.

Symptoms Plus Family History Trump Size in Thoracic Aortic Aneurysm

Right aortic arch and an aberrant left subclavian artery arising from a Kommerell diverticulum complicated by acute aortic dissection Joon Bum Kim, MD,

Descending threshold for ascending aortic aneurysmectomy: Is it time for a “left-shift” in guidelines? Bulat A. Ziganshin, MD, PhD, Mohammad A. Zafar,

John A. Elefteriades, MD, PhD(hon), Mohammad A

Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Wei-Guo Ma, MD, PhD, Wei Zhang, MD, Long-Fei.

Successful surgical treatment of multilevel aortic aneurysms combined with renal transplantation Ivan Matia, MD, PhD, Jan Pirk, MD, PhD, Květoslav Lipar,

Paul P. Urbanski, MD, PhD, Vadim Irimie, MD, Lukas Lehmkuhl, MD, PhD

Diameters of the thoracic aorta throughout life as measured with helical computed tomography Alfred Hager, MD, Harald Kaemmerer, MD, VD, PhD, Ulrike.

Penetrating ulcer of the thoracic aorta: What is it

Complicated acute type B aortic dissection with involvement of an aberrant right subclavian artery and rupture of a thoracoabdominal aortic aneurysm,

Graduate Subspecialty and Perceptions of Cardiothoracic Surgery Training: A 60-Year Retrospective Study Mara B. Antonoff, MD, Jessica G.Y. Luc, MD, G.

The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch Shafie S. Fazel, MD, PhD, Hari.

Diseases of the thoracic aorta in women

Enlargement of aortic arch vessels after surgical repair of type A aortic dissection Takashi Yamauchi, MD, PhD, Suguru Kubota, MD, PhD, Toshihiro Ohata,

Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn Sergueï Malikov, MD, PhD, Arnauld Delarue, MD, PhD, Pierre-Olivier.

John.S Ikonomidis, MD, PhD, Robert C Robbins, MD

Thoracic endovascular aortic repair with branched Inoue Stent Graft for arch aortic aneurysms Junichi Tazaki, MD, Kanji Inoue, MD, Hirooki Higami, MD,

Dilatation of the Remaining Aorta After Aortic Valve or Aortic Root Replacement in Patients With Bicuspid Aortic Valve: A 5-Year Follow-Up Nada Abdulkareem,

Natural History of Ascending Aortic Aneurysms in the Setting of an Unreplaced Bicuspid Aortic Valve Ryan R. Davies, MD, Ryan K. Kaple, BA, Divakar Mandapati,

The aortic arch branching pattern found in cattle has a single brachiocephalic trunk originating from the aortic arch and eventually splits into the bilateral.

Ayman Saeyeldin, MD, Mohammad A

Aortic arch aneurysm repair with a new branched device

Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm With a Right-Sided Aortic Arch and Aberrant Left Subclavian Artery Joseph J.

The Aortic Root: Natural History After Root-Sparing Ascending Replacement in Nonsyndromic Aneurysmal Patients Sven Peterss, MD, Rohan Bhandari, MD, John.

Familial Thoracic Aortic Aneurysms and Dissections—Incidence, Modes of Inheritance, and Phenotypic Patterns Gonzalo Albornoz, MD, Michael A. Coady, MD,

The Journal of Thoracic and Cardiovascular Surgery

Straight deep hypothermic circulatory arrest for cerebral protection during aortic arch surgery: Safe and effective Bulat A. Ziganshin, MD, Bijoy G.

Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks John A Elefteriades, MD The Annals of Thoracic.

Endovascular treatment of right-sided subclavian artery aneurysm in a congenitally malformed aortic arch Gabriele Iannelli, MD, Luigi Di Tommaso, MD,

Current Experience With Acute Type B Aortic Dissection: Validity of the Complication- Specific Approach in the Present Era Paris Charilaou, MD, Bulat.

Supra-aortic hybrid endovascular procedures for complex thoracic aortic disease: Single center early to midterm results Yiu Che Chan, BSc MB, BS, MD,

Aortic dimensions in patients with bicuspid and tricuspid aortic valves Veronica Jackson, MD, Christian Olsson, MD, PhD, Per Eriksson, PhD, Anders Franco-Cereceda,

Nicole M. Bhave et al. JIMG 2018;11:

Normal schematic diagram of the aortic arch and the great vessels demonstrates the embryologic origins of the arch and its major branches. Normal schematic.

Fig. 6. Coarctation of aorta in 46-year-old female with hypertension and dyspnea on exertion.Plain radiograph of chest (A) shows left ventricular hypertrophy,

Michael A. Coady, MD, John A. Rizzo, PhD, Graeme L

Invited Commentary The Annals of Thoracic Surgery

Optimization of Aortic Arch Replacement: Two-Stage Approach

Clinical outcomes and fate of the distal aorta following 1-stage repair of extensive chronic thoracic aortic dissection Nicholas T. Kouchoukos, MD, Alexander.

Intimal intussusception: Unusual complication of dissecting aneurysm

Hybrid Repair of an Aortic Arch Aneurysm Using Double Parallel Grafts Perfused by Retrograde Flow in Endovascular Repair Combined With Left Subclavian.

Management of descending aortic dissection

Serial axial MIP images demonstrating the anomalous origin of both the vertebral arteries from the aortic arch beyond the left subclavian artery, along.

A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach Juan Carlos Jimenez, MD, Wesley.

Relationship of aortic cross-sectional area to height ratio and the risk of aortic dissection in patients with bicuspid aortic valves Lars G Svensson,

Presentation transcript:

Bovine Arch – A Marker for Thoracic Aortic Aneurysm Remo Moomiaie, MD a, Matthew Hornick, BA a, Hamid Mojibian, MD b, Esther S. Lee, BA b, Maryann Tranquilli, RN a, John A. Rizzo, PhD c, and John A. Elefteriades, MD a Section of Cardiac Surgery a and Department of Radiology b, Yale University School of Medicine, New Haven, CT; Departments of Preventive Medicine & Economics c, Stony Brook School of Medicine, Stony Brook, NY.

1. 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: “Bovine arch” refers to group of congenital variants of human aortic arch vessels in which there is aberrant origin of the left common carotid artery. Two anatomic configurations*: 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. 2

Study Aims Bovine arch traditionally viewed as “normal,” clinically insignificant variant Clinicians have noted in general terms that bovine arch is common in patients with thoracic aortic aneurysm (TAA) This study aims to better define association between bovine arch and aortic disease, including TAA development and complications

Patient Population Aneurysm Group: 175 patients with known TAA and thoracic CT or MRI scan on record, randomly selected from Yale Center for Thoracic Aortic Disease database Control Group: 240 patients without TAA, randomly selected from all patients who underwent thoracic CT scan at Yale-New Haven Hospital between May 2006 and May 2008

Methods Thoracic scans of TAA group and control group retrospectively reviewed for presence of bovine arch, and imaging reports screened for citation of bovine arch by radiologist TAA patients’ charts retrospectively reviewed for serial TAA diameter, presence of bicuspid aortic valve, and clinical outcomes (dissection, rupture, repair) TAA growth rate = (final diameter – initial diameter)/ duration between scans

Results: Bovine Arch and TAA ANEURYSM GROUPBA+BA-% BA+P value (vs. comparison) All TAA (n=174) < (vs. No TAA) Ascending TAA (vs. Desc) Descending TAA (vs. Root) Arch TAA060 Root TAA (vs. Asc) CONTROL GROUP No TAA (n=240) BA+ 16 BA- 224 %BA+ 6.7 P value (vs. comparison) < (vs. All TAA) Incidence of bovine arch significantly greater in patients with TAA than in patients without TAA Bovine arch not significantly associated with aneurysms at any particular location Imaging reports (radiologists) cited bovine arch in only 6 of 36 bovine arch patients Table 1. Incidence of Bovine Arch (BA) by TAA Location and Compared to Non-TAA Control Group

Results: Bovine Arch and TAA Incidence of Bovine Arch (BA) by TAA Location and Compared to Non-TAA Control Group Bovine arch significantly more common in patients with TAA than in patients without TAA

Results: TAA Growth Rate and Bovine Arch PopulationAll patients*BA- (n)BA+ (n) p value (BA- vs. BA+) Overall TAA (46) 0.42 (23) Chronic dissection (12)0.57 (9)0.046 No dissection (35)0.33 (14)0.14 Root/Ascending/Arch (27)0.28 (15)0.15 Descending (20)0.68 (8) Coady MA, Rizzo JA, Elefteriades JA. Developing surgical intervention criteria for thoracic aortic aneurysms. Cardiol Clin 1999;17: Table 2. TAA Growth Rate in Patients With and Without Bovine Arch (cm/yr) - comparison data from Coady et al. 3 * TAAs grow significantly faster in patients with bovine arch than in patients without bovine arch Faster expansion rate in setting of bovine arch statistically significant in descending and chronically dissected aneurysms

Results (continued) BA+ (n=36) BA- (n=138) p value (BA- vs. BA+) Type A Type B Total % Dissected Table 3. Dissection in TAA, by BA groupings Higher overall dissection rate in bovine arch patients, but not statistically significant Nearly significant association between bovine arch and type B dissection rate Other results: No significant association between bovine arch and bicuspid aortic valve No significant difference in mean age at TAA discovery or mean age of TAA repair between bovine arch and non-bovine arch groups

Conclusions 1) Bovine aortic arch is significantly more common in patients with TAA than in the general population. 2) Radiology reports often overlook bovine arch. 3) Aortas in bovine arch patients grow faster than general TAAs. 4) Bovine arch patients tend to dissect, especially in the descending aorta.

Conclusions (continued) 5) These observations argue strongly that bovine arch should not be considered a normal variant of aortic arch anatomy.

Recommendations 1) We encourage radiologists to consistently report bovine arch anatomy on thoracic scans, for purposes of serial follow-up to monitor for TAA development. 2) Since “bovine arch” is a misnomer, we propose the name “common origin aortic arch” to describe this group of anatomic variants.