Common Trunk Origin of the Left Vertebral Artery, Left Internal Mammary Artery and Thyrocervical Trunk in a Bovine Arch Configuration: A Case Report
Vivek Khandelwal1*, Rajeev Sivasankar2
1Department of Interventional Radiology, Fortis Hospital Mulund, Mumbai, India.
2Department of Interventional Radiology, Fortis Hospital Mulund, Mumbai, India.
*Corresponding Author: Vivek Khandelwal, Department of Interventional Radiology, Fortis Hospital, Mulund, Mumbai, India.
DOI: https://doi.org/10.58624/SVOANE.2026.07.034
Received: August 12, 2026
Published: September 05, 2026
Citation: Khandelwal V, Sivasankar R. Common Trunk Origin of the Left Vertebral Artery, Left Internal Mammary Artery and Thyrocervical Trunk in a Bovine Arch Configuration: A Case Report. SVOA Neurology 2026, 7:4, 269-272. doi.org/10.58624/SVOANE.2026.07.034
Abstract
Aortic arch branching variants are often seen on cross-sectional and catheter angiography, but combined anomalies that involve the left internal mammary artery, left vertebral artery, and thyrocervical trunk are extremely rare. The bovine arch, which refers to a common origin of the brachiocephalic trunk and left common carotid artery, is one of the more frequent supra-aortic branching variants and has procedural significance during neurovascular and cardiothoracic interventions. This report presents a 74-year-old woman who was evaluated for left upper limb and left lower limb weakness. Magnetic resonance angiography and digital subtraction angiography showed a bovine arch configuration with a separate anomalous common trunk arising from the aortic arch between the bovine left common carotid origin and the left subclavian artery; this trunk gave rise to the left internal mammary artery, left vertebral artery, and thyrocervical trunk. Recognizing this anatomy is of critical importance, as anomalous branch origins can have implications on arch catheterization, selective vertebral cannulation, interpretation of angiography, and any cardiothoracic or endovascular procedures.
Keywords: Aortic Arch Variant; Bovine Arch; Left Vertebral Artery; Left Internal Mammary Artery; Thyrocervical Trunk; Digital Subtraction Angiography
