Managing Cervical Aortic Arches in the Adult Population: a Meta-analysis of Case Reports

P0208 

Abstract Submission 

Massimo Baudo (1), Serge Sicouri (1), Basel Ramlawi (2)

(1) Lankenau Institute for Medical Research, Wynnewood, PA, (2) Lankenau Heart Institute, Wynnewood, PA

Massimo Baudo    -  Contact Me
Lankenau Institute for Medical Research

Serge Sicouri    -  Contact Me
Lankenau Institute for Medical Research

*Basel Ramlawi    -  Contact Me
Lankenau Heart Institute

Massimo Baudo    -  Contact Me
Spedali Civili di Brescia

Objective: The cervical aortic arch (CAA) is an uncommon congenital anomaly in aortic development, characterized by an elongated aortic arch extending at or above the medial ends of the clavicles, and occasionally prominently into the neck. Our objective was to examine the clinical and surgical characteristics of this infrequent condition in the adult population.
Methods: PubMed, ScienceDirect, SciELO, DOAJ and Cochrane Library databases were searched until December 2023 for case reports describing the presence of a cervical aortic arch in the adult age. Case reports and series were included if the following criteria were met: 1) description of the cervical aortic arch; 2) age ≥18 years 3) English language. Exclusion criteria for analysis were all other forms of papers that did not have individual patient data.
Results: The literature search identified 2325 potentially eligible articles, 61 of which met our inclusion criteria with 71 patients. Mean age was 38.6  15.4 years, with a female prevalence of 67.1% (47/70). Two-thirds of the CAA were left-sided (48/71, 67.6%) and 62.0% (44/71) of patients presented a concomitant aneurysm. Asymptomatic patients were 45.7% (32/70), while among those symptomatic, symptoms related to vascular-induced compression of trachea and esophagus (coughing, dysphagia, wheezing, etc.), were present in 60.5% (23/38). Surgery was performed in 42 patients (62.7%) among 67 cases that reported the patient's treatment, and 5 patients (11.9%) among those surgically treated underwent the procedure through an endovascular approach. The intervention resolved compression symptoms in all surgically treated patients. Five patients (7.5%) rejected any invasive intervention despite being indicated and opted for a more conservative approach. Only one death was reported occurring in a critical patient presenting with a dissecting aneurysm and considered at inoperable risk.
Conclusion: Cervical aortic arch is an uncommon congenital heart condition that presents challenges in diagnosis and treatment due to its high anatomical variability, diverse clinical manifestations, and presence of concomitant diseases. Surgical intervention appears to be a safe and effective resolution for symptoms, albeit requiring an individualized approach.

Aortic Arch