Optimal Sizing of Aortic Stent Graft for Blunt Thoracic Aortic Injury Considering Hypotension-Related Decrease in...

Area of Science:

• Cardiovascular Surgery
• Trauma Surgery
• Vascular Imaging

Background:

• Blunt thoracic aortic injury (BTAI) requires prompt intervention, often via thoracic endovascular aortic repair (TEVAR).
• Accurate stent graft sizing is critical for successful TEVAR, but hypovolemia can temporarily reduce aortic diameter, complicating sizing decisions.
• Optimal stent graft sizing strategies for BTAI patients experiencing hemodynamic instability remain an area of investigation.

Purpose of the Study:

• To determine the optimal aortic stent graft sizing for patients with blunt thoracic aortic injury (BTAI).
• To evaluate the impact of hypovolemic status on aortic diameter and its influence on stent graft selection.
• To assess the safety and efficacy of oversized stent grafts in hemodynamically unstable BTAI patients.

Main Methods:

• A retrospective review of 25 patients who underwent TEVAR for BTAI between 2014 and 2020.
• Collection of hemodynamic parameters in the emergency room (ER) and prior to the main procedure (MP).
• Measurement of aortic sizes using initial CT, aortography (AG) during TEVAR, and final outpatient CT scans.

Main Results:

• Patients with systolic blood pressure (SBP) ≤90 mm Hg or mean blood pressure (MBP) ≤70 mm Hg at MP showed significantly larger aortic size increases from initial imaging to final CT.
• On average, stent grafts were oversized by 130% based on initial aortography, with final CT measurements indicating an average oversizing of 122%.
• A 130% oversizing of the stent graft was found to be safe and effective in reducing endoleaks in hemodynamically unstable patients.

Conclusions:

• Aortic diameter can decrease by over 15% in hemodynamically unstable BTAI patients compared to normal states, even after resuscitation.
• A 130% oversized stent graft in TEVAR for BTAI in unstable patients ensures appropriate sizing upon hemodynamic recovery.
• Oversizing stent grafts by 130% in TEVAR for BTAI in hemodynamically unstable patients is a safe and effective strategy to prevent endoleaks.