Higher Prevalence of Bovine Aortic Arch Configuration in Patients Undergoing Blunt Isthmic Aortic Trauma Repair

Mertens, Renato; Velásquez, Fernando; Mertens, Nicolás; Vargas, Francisco; Torrealba, José Ignacio; Marine, L; Bergoeing, Michel; Valdés, F

doi:10.1016/j.avsg.2019.10.080

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…Patients with bovine arch showed the second highest prevalence of thoracic aneurysm (13%) after those with right-sided arch combined with aberrant left subclavian configuration (33%) and before those with aberrant right subclavian artery (8.2%). A significantly higher prevalence of bovine arch was also observed by Martens et al [39] in male patients undergoing blunt isthmic aortic trauma repair (57.6%) versus controls (34.8%), playing in favor of a role of bovine arch in facilitating trauma effects on the aorta. Finally, children with bovine arch anatomy and coarctation are at a significantly higher risk of re-coarctation following coarctation repair [40].…”

Section: Discussionsupporting

confidence: 58%

A Combined Deep Learning System for Automatic Detection of “Bovine” Aortic Arch on Computed Tomography Scans

Secchi

Interlenghi²,

Alì

et al. 2022

Applied Sciences

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The “bovine” aortic arch is an anatomic variant consisting in a common origin of the innominate and left carotid artery (CILCA), associated with a greater risk of thoracic aortic diseases (aneurysms and dissections), stroke, and complications after endovascular procedures. CILCA can be detected by visual assessment of computed tomography (CT) chest scans, but it is rarely reported. We developed a deep learning (DL) segmentation-plus-classification system to automatically detect CILCA based on 302 CT studies acquired at 2 centers. One model (3D U-Net) was trained from scratch (supervised by manual segmentation), validated, and tested for the automatic segmentation of the aortic arch and supra-aortic vessels. Three DL architectures (ResNet50, DenseNet-201, and SqueezeNet), pre-trained over millions of common images, were trained, validated, and tested for the automatic classification of CILCA versus non-CILCA, supervised by radiologist’s classification. The 3D U-Net-plus-DenseNet-201 was found to be the best system (Dice index 0.912); its classification performance obtained from internal, independent testing on 126 patients gave a receiver operating characteristic area under the curve of 87.0%, sensitivity 66.7%, specificity 90.5%, positive predictive value 87.5%, negative predictive value 73.1%, positive likelihood ratio 7.0, and negative likelihood ratio 0.4. In conclusion, a combined DL system applied to chest CT scans was developed and proven to be an effective tool to detect individuals with “bovine” aortic arch with a low rate of false-positive findings.

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Section: Discussionsupporting

confidence: 58%

A Combined Deep Learning System for Automatic Detection of “Bovine” Aortic Arch on Computed Tomography Scans

Secchi

Interlenghi²,

Alì

et al. 2022

Applied Sciences

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“…Importantly, the first evidence in the currently available literature suggests that a bovine (or gothic) arch should be considered a potential risk factor for the development of a thoracic aortic aneurysm [ 14 ]. Further, a higher incidence of bovine arches in patients requiring surgical treatment for traumatic isthmic aortic transection was reported [ 15 ]. Pointing in the same direction, Sun et al found that the greater angulation and tortuosity of the aortic arch is associated with TBAD [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection

Mulorz,

Garcon,

Arnautovic

et al. 2023

JCM

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Objective: The incidence of type B aortic dissection (TBAD) is increasing worldwide; however, the underlying pathomechanisms are not conclusively understood. This study explores the geometric architecture of the aortic arch and supra-aortic branches in TBAD patients as opposed to non-TBAD patients. Methods: Patient characteristics were retrieved from archived medical records. Computer-assisted tomography (CAT) scans of patients with TBAD and carotid stenosis (CS) from two high-volume centers were analyzed. Various aortic arch parameters and take-off angles of the supra-aortic branches of TBAD patients were measured following centerline normalization in comparison CS patients. A compression index (C-index) was calculated from the para-sagittal, and a torsion index (T-index) was calculated from the para-coronal take-off angles of the supra-aortic branches to analyze aortic arch tortuosity. Results: A total of 199 CAT scans were analyzed, namely, 85 in the TBAD group and 114 in the CS group. The average age was 61.5 ± 13.1 years among the TBAD patients and 71 ± 9.3 years among the CS patients. We found a significantly higher proportion of type III aortic arch configurations in TBAD patients compared with CS patients. Further, the aortic arch angle was steeper in the TBAD group. In the para-sagittal plane, the left subclavian artery (LSA) take-off angle was less steep in TBAD patients. In the para-coronal plane, the left carotid artery (LCA) had a less steep take-off angle, while the LSA had a more obtuse take-off angle in the TBAD group when compared with the CS group. In addition, the inter-vessel distance was increased in TBAD patients. Finally, the T-index was increased, suggesting a significant torsion resulting from the deviating take-off angles of the supra-aortic branches supplying the left half of the body as opposed to the innominate artery (IA) in TBAD patients. Conclusions: Our results suggest several aortic arch-specific geometric configurations in patients suffering from TBAD that significantly differ from those in CS patients. Further functional studies are needed to verify the pathogenetic relevance of our results and their disease-specific causality. Although our data are not mechanistically explorative, they may serve as a basis for identifying future patients with aortic arch morphology at higher risk for TBAD development and who may benefit from more stringent adjustment of risk factors as a primary prevention concept.

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“…The most commonly involved section of the aorta is its isthmus (exactly distal to the subclavian artery). The reason for such a vulnerability is determined to be its location between the more mobile part (ascending aorta and arch) and the relatively fixed zone of the descending thoracic aorta [ 6 ]. The entrapment of the isthmus section between anterior and posterior bony structures also makes this part more vulnerable to focal rupture [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…The reason for such a vulnerability is determined to be its location between the more mobile part (ascending aorta and arch) and the relatively fixed zone of the descending thoracic aorta [ 6 ]. The entrapment of the isthmus section between anterior and posterior bony structures also makes this part more vulnerable to focal rupture [ 6 ]. Moreover, the aortic tissue in the isthmus has weaker tensile, making it intrinsically more prone to these injuries [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

Sadeghian,

Ebrahimi,

Soltani

et al. 2024

Int J Emerg Med

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Background Blunt traumatic aortic injury (BTAI) is the second leading cause of death due to traumas in young patients. The primary presentation might be chest or interscapular pain, difficulty in breathing, and, in severe cases, hypotension. Considering the rapid deterioration of these patients’ clinical conditions, prompt diagnosis and treatment initiation are crucial. In these injuries, the most involved parts of the aorta are the isthmus (distal to the left subclavian artery) and the descending part in the thorax. Therefore, the main diagnostic strategies include transthoracic echocardiography, CT angiography, and endovascular diagnostic approaches. Case presentation The patient was a 19-year-old male presenting with the symptoms of chest pain, dyspnea, and extremities excruciating pain after a car turnover. The initial evaluation showed no abnormal cardiovascular finding except bilateral hemothorax, addressed with chest tubes. Twelve hours later, when the patient was under observation for orthopedic surgeries, his chest pain and dyspnea started, and TTE and CTA showed a grade three descending aneurysm of the aorta. The patient was treated immediately with an endovascular procedure of stent implantation. A delayed debranching surgery was also performed, which resulted in desirable outcomes and uneventful follow-up. Conclusion Although open thoracic surgery is the main and almost the only option for treating aneurysms of the aorta in hemodynamically unstable patients, the endovascular procedure has shown superior outcomes in selected patients with appropriate anatomy. Debranching surgery, which can be done simultaneously or with delay after the initial procedure, has proven protective against thromboembolic cerebral events. Clinical key point Patients with an aneurysm of the aorta should be transported to a medical center with a multidisciplinary team for an urgent evaluation and treatment. The initial resuscitation and diagnosis are challenging, considering the fatal nature of these injuries, and the selection of the treatment is based on the patient's clinical condition and evaluated anatomy in cardiovascular imaging.

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Higher Prevalence of Bovine Aortic Arch Configuration in Patients Undergoing Blunt Isthmic Aortic Trauma Repair

Cited by 9 publications

References 18 publications

A Combined Deep Learning System for Automatic Detection of “Bovine” Aortic Arch on Computed Tomography Scans

A Combined Deep Learning System for Automatic Detection of “Bovine” Aortic Arch on Computed Tomography Scans

The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

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