Endovascular Repair of Blunt Aortic Trauma: A Multidisciplinary Approach and a Retrospective Multicenter Study

Background/Objectives: Blunt traumatic thoracic aortic injury is a rare but often fatal condition, typically resulting from high-energy deceleration mechanisms such as motor vehicle collisions or falls from height. Mortality can reach 80-90% at the scene, with in-hospital mortality up to 46%. Early diagnosis and appropriate management are essential to improve outcomes. Methods: We retrospectively analyzed 45 patients (29 males, 16 females) with varying degrees of aortic isthmus injury treated between January 2007 and December 2024 at two Italian vascular surgery centers. Aortic lesions were graded 0-3, with 40 patients undergoing thoracic endovascular aortic repair. Procedures utilized Gore TAG or Medtronic Valiant endografts. Perioperative management included controlled hypotension and left subclavian artery coverage was performed when necessary. Results: Procedural success was achieved in all patients (100%), with one type II endoleak. No perioperative complications or spinal cord ischemia were observed. Coverage of the left subclavian artery was required in 28.9% of cases. Thirty-day mortality was 9%, with no deaths directly attributable to aortic injury. Postoperative CTA confirmed adequate endograft placement in all patients. Conclusions: Endovascular repair is a safe and effective approach for BTAI, with excellent short-term outcomes. Management should be tailored to injury severity and patient comorbidities, with ongoing vigilance for spinal cord ischemia.