Aberrant left vertebral and aberrant right subclavian arteries in blunt thoracic aortic injury patients: A multicenter registry study.

OBJECTIVES: Congenital aortic arch variants may complicate thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI), particularly when left subclavian artery (LSA) coverage is required. While bovine arch anatomy has been studied, the clinical relevance of rarer variants such as aberrant left vertebral artery (ALV) and aberrant right subclavian artery (ARS) remains unclear. We sought to determine the prevalence of ALV and ARS in BTAI patients and assess their association with injury severity and adjunctive LSA revascularization during TEVAR. METHODS: We performed a retrospective analysis of prospectively collected data from the Aortic Trauma Foundation multicenter registry (2007-2025). Arch anatomy was classified as ALV, ARS, or other. Variant prevalence was compared with reported non-trauma population estimates using exact binomial testing. Among patients undergoing TEVAR with LSA coverage, multivariable Firth penalized logistic regression evaluated whether ALV was independently associated with the need for additional procedures to maintain left upper extremity perfusion, adjusting for demographic factors, and injury variables. Injury severity was compared using nonparametric testing. A post-hoc analysis assessed differences in postoperative complications among patients undergoing TEVAR with LSA coverage based on the presence of ALV anatomy via Fischer's exact test. RESULTS: Among 1,331 patients, ALV and ARS were identified in 1.43% and 0.38%, respectively. ALV prevalence was significantly lower than reported population estimates (p < 0.001). TEVAR was performed in 45% of patients, with LSA coverage in 17%. Neither ALV nor ARS was associated with higher BTAI grade, and the presence of ALV was not associated with increased need for additional interventions after LSA coverage or differences in postoperative complications. CONCLUSIONS: ALV and ARS were uncommon in BTAI patients, and we did not detect an association between these variants and injury severity, the need for adjunctive LSA revascularization procedures, or early postoperative outcomes. Given the rarity of these variants, larger studies are needed to better define their procedural implications and long-term clinical significance.