This review article looks into the role of ´bovine´ aortic arch configuration as a risk factor for aortic disease. An arch configuration with common origin of the innominate and left carotid artery was associated with a higher risk of thoracic aortic dissection when looking at the results of 485 studies, including 11,381 patients. The authors concluded that ´bovine´ aortic arch configuration should be recognized as a risk factor for aortic disease.