Introduction
Aortic arch anomalies constitute a broad spectrum of congenital variants of the development of the aortic arch and great vessels. During embryology, bilateral ventral and dorsal aortae are connected by arches, most of them regress except for the 3rd arch that gives rise to the carotid arteries, the 4th arch that gives rise to the adult arch, and the 6th arch that gives rise to the ductus arteriosus 1. Due to this complex developmental process, variations or anomalies of the arch and its branches may occur 2. Anomalies of the origin of arch vessels include common origin of the left common carotid and the brachiocephalic arteries (bovine arch) 3, aberrant origin of the right and left subclavian arteries from the descending aorta that sometimes originate from a localized dilatation called Kommerell’s diverticulum 4,5, and aberrant origin of the left vertebral artery from the arch itself rather than originating from the left subclavian artery 6. Anomalies of the laterality and position of the arch includes double arch, right sided arch, circumflex arch, cervical arch, interrupted arch, and pseudocoarctation 7,8. Some variants are reported to be very common in the general population, with example bovine arch reported to have a prevalence of ~20%, while other variants such as double and cervical arch patterns are rare2. It has been reported that arch anomalies are associated with increased incidence of congenital heart disease9 and also thoracic aortopathies 10, although large population studies on arch anomalies are lacking. We assessed our institutional CT scan database to better understand the prevalence of arch anomalies in the older adult population age> 50 years, and its possible association with the thoracic aortic aneurysm disease.