Bovine arch
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Bovine arch is the most common variant of the aortic arch and occurs when the brachiocephalic (innominate) artery shares a common origin with the left common carotid artery.
A bovine arch is apparent in ~15% (range 8-25%) of the population and is more common in individuals of African descent.
A related variant, also known as truncus bicaroticus, is the shared origin of the left and right common carotid arteries separate from the right subclavian artery.
Sometimes it can be difficult to distinguish these different patterns because there is a continuous spectrum between arterial origins that are clearly separate, to origins that are adjacent (or common), to the those where there is clear common trunk before bifurcation.
As can be seen in the provided cases, a bovine arch with a lower origin of the left common carotid artery from the brachiocephalic artery but not sharingtends to result in a true common origin, which occurs in ~9%more "V-shaped" course of the populationdistal vessels. Sometimes this can be difficult to distinguish from a commonBovine arches with an origin becauseof the left common carotid artery arises within 1 cm offurther distal on the originbrachiocephalic artery typically results in the left common carotid artery having a more horizontal configuration that is close to 180o relative to the distal course of the brachiocephalic artery.
The bovine arch is not the typical aortic arch pattern in bovines. Bovines have a common single brachiocephalic trunk which trifurcates into bilateral subclavian arteries and a single bicarotid trunk. This pattern is very rare in humans. When it occurs, however, it is typically referred to as a true bovine arch.
Clinical presentation
This common variant is asymptomatic most of the time. In rare cases of head and neck surgery, e.g. tracheostomy, it can be a risk factor for injury and cause complications 4. In combination with an aberrant right subclavian artery it can cause a dysphagia lusoria.
Clinical relevance
Variations in aortic branch anatomy, such as the bovine arch, are primarily of importance to interventional neuroradiology. Historically, in order to minimise contrast use, an aortic DSA is typically not performed unless there are difficulties in engaging the head and neck vessels. One technique to engage the left common carotid artery is to slowly withdraw the catheter from the brachiocephalic artery. As it disengages from the brachiocephalic origin the catheter will typically slip into the left common carotid. When the vessel cannot be located this way, an arch aortogram will be performed to assist location of the vessels. An important clue to the presence of a bovine arch is the horizontal path of the proximal left common carotid artery. With the widespread use of cross sectional imaging the anatomy is now usually able to be identified prior to angiography.
Given the challenges in catheterisation, it is perhaps unsurprising that the main clinical relevance of a bovine arch is an increase in complications reported during interventional procedures 6.
History and etymology
TheThere has been recent debate about the origin of the name stems from the similarity of this variant with1,5,6. In 2006 Layton et al. highlighted that of a normal bovine arch. A truethe bovine arch (aspattern is not the normal aortic branching pattern found in cattlebovines (cattle etc) has a common single brachiocephalic trunk which trifurcates into bilateral subclavian arteries and a single bicarotid trunk. This variation is very rare in humans.
Therefore calling. Based on this they concluded the arrangement described in this articleas "a bovine arch" is a misnomer. TheTheir preferred terminology is "common origin of the brachiocephalic artery and left common carotid artery" 5 1.
Presumably somewhereThe alternative view points out that there is no evidence that the description arose from the comparative anatomy with bovines 5,6. The pattern in bovines has been known since at least 1933. Bovine arch first appeared in the animal kingdom is an animal whose aorta actually branches like the so-called bovine patternliterature in 1988. Proposed names are feline/canine/lapine arch.
The term truncus bicaroticus is also not consistent andAs can be misleadingseen in the Radiopaedia collection of Animal and animal produce inspired signs, there are many ways that a name is linked to an animal. The most common is that the appearance (such as radiological, pathological or anatomical) resembles that of an animal. Among the branchingnumerous examples include the Scotty dog appearance, Leaping dolphin sign or Fishtail pancreas. In some cases the sign occurs because the human variant is the normal pattern not only includesin an animal, such as Pig bronchus (and, indeed, the right"true bovine arch"). Less common naming associations include movement being likened to an animal, such as Jellyfish sign (ultrasound), or even human behaviour resembling an animal, such as Pica.
In the case of the bovine arch, the 180o angle of the bifurcation resembles the 180o angle of the horns of a bovine. This is the likely origin of the term "bovine arch". The fact that the pattern does not occur in bovines does not render the term a misnomer. A Butterfly vertebra, for example, would never be considered a misnomer even though butterflies do not have vertebrae 5.
For those interested in comparative anatomy, the bovine arch pattern is common in dogs, cats, rabbits and left common carotid artery, but also the right subclavian arterya number of primates 6.
-<p><strong>Bovine arch </strong>is the most common <a href="/articles/variant-of-the-aortic-arch">variant of the aortic arch</a> and occurs when the <a href="/articles/brachiocephalic-trunk">brachiocephalic (innominate)</a><a href="/articles/brachiocephalic-trunk"> artery</a> shares a common origin with the left <a href="/articles/common-carotid-artery-2">common carotid artery</a>. </p><p>A bovine arch is apparent in ~15% (range 8-25%) of the population and is more common in individuals of African descent. </p><p>A related variant, also known as <strong>truncus bicaroticus</strong>, is the origin of the left common carotid artery from the brachiocephalic artery but not sharing a true common origin, which occurs in ~9% of the population. Sometimes this can be difficult to distinguish from a common origin because the left common carotid artery arises within 1 cm of the origin of the brachiocephalic artery.</p><h4>Clinical presentation</h4><p>This common variant is asymptomatic most of the time. In rare cases of head and neck surgery, e.g. tracheostomy, it can be a risk factor for injury and cause complications <sup>4</sup>. In combination with an <a href="/articles/aberrant-right-subclavian-artery">aberrant right subclavian artery</a> it can cause a <a href="/articles/dysphagia-lusoria">dysphagia lusoria</a>.</p><h4>History and etymology</h4><p>The name stems from the similarity of this variant with that of a normal bovine arch. A true bovine arch (as found in cattle) has a common single brachiocephalic trunk which trifurcates into bilateral subclavian arteries and a single bicarotid trunk. This variation is very rare in humans.</p><p>Therefore calling the arrangement described in this article "a bovine arch" is a misnomer. The preferred terminology is "common origin of the brachiocephalic artery and left common carotid artery"<sup> 5</sup>.</p><p>Presumably somewhere in the animal kingdom is an animal whose aorta actually branches like the so-called bovine pattern. Proposed names are feline/canine/lapine arch.</p><p>The term truncus bicaroticus is also not consistent and can be misleading as the branching pattern not only includes the right and left common carotid artery, but also the right subclavian artery.</p>- +<p><strong>Bovine arch </strong>is the most common <a href="/articles/variant-of-the-aortic-arch">variant of the aortic arch</a> and occurs when the <a href="/articles/brachiocephalic-trunk">brachiocephalic (innominate) artery</a> shares a common origin with the left <a href="/articles/common-carotid-artery-2">common carotid artery</a>. </p><p>A bovine arch is apparent in ~15% (range 8-25%) of the population and is more common in individuals of African descent. </p><p>A related variant, also known as <strong>truncus bicaroticus</strong>, is the shared origin of the left and right common carotid arteries separate from the right subclavian artery. </p><p>Sometimes it can be difficult to distinguish these different patterns because there is a continuous spectrum between arterial origins that are clearly separate, to origins that are adjacent (or common), to the those where there is clear common trunk before bifurcation. </p><p>As can be seen in the provided cases, a bovine arch with a lower origin of the left common carotid artery from the brachiocephalic artery tends to result in a more "V-shaped" course of the distal vessels. Bovine arches with an origin of the left common carotid artery further distal on the brachiocephalic artery typically results in the left common carotid artery having a more horizontal configuration that is close to 180<sup>o</sup> relative to the distal course of the brachiocephalic artery.</p><p>The bovine arch is not the typical aortic arch pattern in bovines. Bovines have a common single brachiocephalic trunk which trifurcates into bilateral subclavian arteries and a single bicarotid trunk. This pattern is very rare in humans. When it occurs, however, it is typically referred to as a true bovine arch.</p><h4>Clinical presentation</h4><p>This common variant is asymptomatic most of the time. In rare cases of head and neck surgery, e.g. tracheostomy, it can be a risk factor for injury and cause complications <sup>4</sup>. In combination with an <a href="/articles/aberrant-right-subclavian-artery">aberrant right subclavian artery</a> it can cause a <a href="/articles/dysphagia-lusoria">dysphagia lusoria</a>.</p><h5>Clinical relevance</h5><p>Variations in aortic branch anatomy, such as the bovine arch, are primarily of importance to interventional neuroradiology. Historically, in order to minimise contrast use, an aortic DSA is typically not performed unless there are difficulties in engaging the head and neck vessels. One technique to engage the left common carotid artery is to slowly withdraw the catheter from the brachiocephalic artery. As it disengages from the brachiocephalic origin the catheter will typically slip into the left common carotid. When the vessel cannot be located this way, an arch aortogram will be performed to assist location of the vessels. An important clue to the presence of a bovine arch is the horizontal path of the proximal left common carotid artery. With the widespread use of cross sectional imaging the anatomy is now usually able to be identified prior to angiography.</p><p>Given the challenges in catheterisation, it is perhaps unsurprising that the main clinical relevance of a bovine arch is an increase in complications reported during interventional procedures <sup>6</sup>.</p><h4>History and etymology</h4><p>There has been recent debate about the origin of the name <sup>1,5,6</sup>. In 2006 Layton et al. highlighted that the bovine arch pattern is not the normal aortic branching pattern found in bovines (cattle etc). Based on this they concluded the arrangement described as "a bovine arch" is a misnomer. Their preferred terminology is "common origin of the brachiocephalic artery and left common carotid artery"<sup> 1</sup>.</p><p>The alternative view points out that there is no evidence that the description arose from the comparative anatomy with bovines <sup>5,6</sup>. The pattern in bovines has been known since at least 1933. Bovine arch first appeared in the literature in 1988. As can be seen in the Radiopaedia collection of <a href="/articles/animal-and-animal-produce-inspired-signs" title="Animal and animal produce inspired signs">Animal and animal produce inspired signs</a>, there are many ways that a name is linked to an animal. The most common is that the appearance (such as radiological, pathological or anatomical) resembles that of an animal. Among the numerous examples include the <a href="/articles/scottie-dog-sign-spine" title="Scotty dog appearance">Scotty dog appearance</a>, <a href="/articles/leaping-dolphin-sign" title="Leaping dolphin sign">Leaping dolphin sign</a> or <a href="/articles/fishtail-pancreas" title="Fishtail pancreas">Fishtail pancreas</a>. In some cases the sign occurs because the human variant is the normal pattern in an animal, such as <a href="/articles/tracheal-bronchus" title="Pig bronchus">Pig bronchus</a> (and, indeed, the "<strong>true bovine arch</strong>"). Less common naming associations include movement being likened to an animal, such as <a href="/articles/jellyfish-sign-ultrasound" title="Jellyfish sign (ultrasound)">Jellyfish sign (ultrasound)</a>, or even human behaviour resembling an animal, such as <a href="/articles/pica-1" title="Pica">Pica</a>.</p><p>In the case of the bovine arch, the 180<sup>o</sup> angle of the bifurcation resembles the 180<sup>o</sup> angle of the horns of a bovine. This is the likely origin of the term "bovine arch". The fact that the pattern does not occur in bovines does not render the term a misnomer. A <a href="/articles/butterfly-vertebra" title="Butterfly vertebra">Butterfly vertebra</a>, for example, would never be considered a misnomer even though butterflies do not have vertebrae <sup>5</sup>.</p><p>For those interested in comparative anatomy, the bovine arch pattern is common in dogs, cats, rabbits and a number of primates <sup>6</sup>.</p>
References changed:
- 5. Ridley L, Han J, Xiang H. The "Bovine Aortic Arch": Time to Rethink the True Origin of the Term? AJNR Am J Neuroradiol. 2019;40(2):E7-8. <a href="https://doi.org/10.3174/ajnr.A5924">doi:10.3174/ajnr.A5924</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30679222">Pubmed</a>
- 6. Han J, Xiang H, Ridley W, Ridley L. Bovine Aortic Arch. J Med Imag Rad Onc. 2018;62(S1):20-1. <a href="https://doi.org/10.1111/1754-9485.08_12785">doi:10.1111/1754-9485.08_12785</a>
- 5. Layton KF, Kallmes DF, Cloft HJ, Lindell EP, Cox VS. Bovine aortic arch variant in humans: clarification of a common misnomer. (2006) AJNR. American journal of neuroradiology. <a href="https://doi.org/">doi:</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16908576">Pubmed</a> <span class="ref_v4"></span>
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