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Long-term Outcomes of Endovascular Repair for Blunt Thoracic Aortic Injury: A 10 Year Multi-center Experience

Mingwei Wu¹, Zhaoxiang Zeng², Xianhao Bao²

¹Department of Vascular and Endovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists

|April 12, 2024

Insights

Thoracic endovascular aortic repair (TEVAR) is safe and effective for blunt thoracic aortic injuries (BTAI), showing excellent long-term outcomes. Extended follow-up is recommended for younger patients to monitor potential endograft-aorta mismatch over time.

Area of Science:

Vascular Surgery
Trauma Surgery
Cardiovascular Imaging

Background:

Blunt thoracic aortic injuries (BTAI) are severe trauma with high mortality.
Thoracic endovascular aortic repair (TEVAR) has emerged as a less invasive alternative to open repair.
Long-term outcomes of TEVAR for BTAI require further investigation.

Purpose of the Study:

To assess the long-term safety and effectiveness of TEVAR in patients with BTAI.
To evaluate clinical outcomes and complications following TEVAR for BTAI.

Main Methods:

Retrospective observational study at 3 centers from January 2010 to December 2019.
Included 62 consecutive patients with BTAI treated with TEVAR.
Follow-up included CT angiography at 6 months and annually thereafter, with a mean follow-up of 86.82 months.

Main Results:

100% technical success rate across dissection, pseudoaneurysm, and rupture types.
Low in-hospital (1.61%) and all-cause follow-up mortality (3.28%).
Minimal long-term complications: 4.92% branch stenosis/occlusion, with 3.28% requiring re-intervention; no spinal cord ischemia, endoleak, or migration.

Conclusions:

TEVAR demonstrates long-term safety and effectiveness for BTAI.
Extended follow-up is crucial for young BTAI patients to monitor potential endograft-aorta interactions.
This study provides robust evidence supporting TEVAR as a durable treatment option for BTAI.

Read full analysis

Abstract

Objective:

This study aimed to assess the long-term outcomes in patients treated by thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injuries (BTAI).

Materials And Methods:

From January 2010 to December 2019, this retrospective observational study was conducted at 3 centers, involving 62 consecutive BTAI patients who underwent TEVAR. Computed tomography angiography scans were planned to be conducted at 6 months post-procedure, and annually thereafter.

Results:

Technical success was achieved in all 62 procedures (100%), which included cases of dissection (n=35, 56.45%), pseudoaneurysm (n=20, 32.26%), and rupture (n=7, 11.29%). Mean injury severity score was 31.66±8.30. A total of 21 supra-arch branches were revascularized by chimney technique, with 12 cases involving the left subclavian artery (LSA) and 9 cases involving the left common carotid artery. In addition, 11 LSAs were covered during the procedure. The in-hospital mortality rate was 1.61% (n=1). The mean follow-up time was 86.82±30.58 months. The all-cause follow-up mortality rate was 3.28% (n=2). Stenosis or occlusion of 3 supra-arch branches (4.92%) was identified at follow-up, with 2 cases (3.28%) requiring re-intervention. No spinal cord ischemia, endoleak, or migration was observed.

Conclusions:

Despite only including patients with long-term follow-up, this study confirms the long-term safety and effectiveness of TEVAR for BTAI. For young BTAI patients, as the thoracic aorta increases with age, longer follow-up is needed to observe the potential mismatch between the endograft and the aorta.Clinical ImpactThis study confirms the long-term safety and effectiveness of endovascular treatment for blunt thoracic aortic injury (BTAI). For young BTAI patients, as the thoracic aorta increases with age, longer follow-up is needed to observe the potential mismatch between the endograft and the aorta. Through a remarkably extended follow-up period (86.82±30.58 months) conducted at multiple centers in China, this study confirms the long-term safety and effectiveness of endovascular treatment for BTAI.

Keywords:

blunt thoracic aortic injury endograft long-term multi-center study thoracic endovascular aneurysm repair

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