Abstract 19994: Outcomes Following Thoracic Endovascular Aortic Repair in Patients With Bovine Aortic Arch Anatomical Variants: A 14-year Single Centre Experience
Introduction: Bovine aortic arch (BA) anatomical variants have been associated with an increased incidence of thoracic aortic disease but whether this anatomical variant affects outcomes after intervention remains unknown. We compare thoracic endovascular aortic repair (TEVAR) in patients with BA and those with a normal aortic arch configuration (NA).
Methods: A prospectively maintained database of 250 patients who underwent elective and emergency TEVAR between 2000 and 2014 was analysed retrospectively. Computerised tomography angiograms were reconstructed using a TeraRecon Aquarius workstation to assess aortic morphology. Data analysed included in-patient mortality, stroke, papraplegia, incidence of endoleak, coverage/revascularization of the left subclavian artery (LSA) and the length of aorta covered.
Results: Bovine aortic arch variants were identified in 48 patiens (19%), half of whom underwent TEVAR for thoracic aneursymal disease (TAA) and the remaining 24 for thoracic aortic dissection (TAD). Disease aetiology in those with normal arch anatomy was TAA in 116 (57%) and TAD in 86 (43%). There were no significant differences in mortality (BA: 5%, NA: 7%), stroke (BA: 8%, NA: 7%), endoleak (BA: 8%, NA: 6%) or LSA revascularization rate (BA: 8%, NA: 10%) between BA and NA cohort. Operative time (BA: 89mins, NA: 106mins), volume of contrast agent used (BA: 139ml, NA: 152ml) and blood loss (BA: 446ml, NA: 425ml) were comparable. There was a trend for a higher incidence of paraplegia in patients with a bovine aortic arch (10%) compared with those with normal arch anatomy (4%), despite a similar length of aortic coverage by stent graft (BA: 30cm, NA: 29cm). The LSA was covered in 51% of BA patients and 53% of NA patients. Of the patients that became paraplegic 4 (80%) of BA patients had coverage of the LSA without revascularisation, as the left vertebral artery was considered non dominant, compared with 3 (38%) of NA patients.
Conclusions: The bovine aortic arch variant is common in patients with thoracic aortic disease and may be associated with higher rates of paraplegia following TEVAR. We suggest routine revascularization of the LSA when this vessel is covered during TEVAR in patients with a bovine aortic arch.
Author Disclosures: P. Saha: Honoraria; Modest; Bayer. A.S. Patel: None. A. Bajwa: Research Grant; Significant; BHF Clinical Research Training Fellowship. H. Zayed: None. T. Carrell: None. R. Bell: None. B. Modarai: Research Grant; Significant; BHF Intermediate Fellow.
- © 2014 by American Heart Association, Inc.