b'Scientific Session Abstracts SATURDAY APRIL 20, 2024 21: CLINICAL OUTCOMES OF CELIAC ARTERY COVERAGE VS PRESERVATION DURING THORACIC ENDOVASCULAR AORTIC REPAIRNarek Veranyan MD, Daniel Willie-Premor, MD, MPH, CPH;Sina Zarrintan, MD, MS, MPH; Omar Al-Nouri, DO, MS, RPVI, FACS;Mahmoud B. Malas MD, MHS, RPVI, FACSDepartment of Surgery, Division of Vascular & Endovascular Surgery,UC San Diego, San Diego, CABackground: Adequate proximal and distal seal zones are necessary for successful Thoracic Endovascular Aortic Repair (TEVAR). Often, the achievement of an adequate distal seal zone requires celiac artery (CA) coverage by endograft with or without preservation of CA blood flow. The outcomes of CA coverage without its flow preservation were studied only in small case series. Our study aims to determine the difference in outcomes between CA coverage with vs without preservation of CA blood flow during TEVAR using a multi-institutional national database.Methods: Vascular Quality Initiative (VQI) was reviewed for all TEVAR patients distally landing in Zone 6. The cohort was divided into CA coverage with preservation of CA blood flow or CA coverage without flow preservation. Demographic, clinical, and perioperative characteristics, as well as post-operative mortality, morbidities, Major Adverse Cardiovascular Events (MACE, defined as new postoperative myocardial infarction (MI), dysrhythmia, stroke, or congestive heart failure (CHF)), and complications, were compared between the groups. Univariate and multivariate regression analyses were performed.Results: Out of 25,550 reviewed patients, 772 had a distal landing in zone 6, 212 of which (27.5%) had TEVAR without CA flow preservation, whereas 560 (72.5%) underwent TEVAR with CA flow preservation. Indications for TEVAR were: aneurysm in 431 (55.8%), dissection in 247 (32.0%), or other in 94 (12.2%) cases. Table 1 demonstrates the differences in baseline characteristics. There was a trend of increased intestinal ischemia requiring intervention in the non-preserved group (1.9% vs 0.5%, p=0.077). After adjusting for potential confounders, CA coverage without flow preservation was associated with more than a two-fold increase in the overall 30-day mortality (OR: 2.70, 95%CI: 1.12-6.46, p=0.026), about a three-fold increase in disease/treatment-related mortality (OR: 3.21, 95%CI: 1.02-10.13, p=0.047) in the overall sample (Table 2), a 2.95-fold increase in the 30-day mortality (p=0.044) and a 2.77-foldincreased rate of disease/treatment-related mortality in the subgroup with aneurysm (p=0.036), whereas there was no significant association between CA flow preservation status and the endpoints in the dissection subgroup in both univariable and multivariable analyses (Table 3).Conclusions: CA coverage during TEVAR without preservation of its blood flow is associated with significantly higher mortality. Preservation of CA blood flow should be performed when possible, especially in patients with aortic aneurysms. Prospective studies should be done to confirm our findings and compare the open vs endovascular revascularization techniques on outcomes.42 NDANNUAL MEETING|APRIL 1921, 2024|OCEANSIDE, CA 61'