Long-Term Survival following TEVAR for Blunt Thoracic Aortic Injury

Blunt thoracic aortic injury (BTAI) is a leading cause of death in blunt chest trauma. Thoracic endovascular aortic repair (TEVAR) has emerged as the preferred treatment, offering reduced morbidity and improved survival compared with open repair. This study evaluates long-term outcomes of TEVAR for BTAI at a single Canadian center.

We retrospectively reviewed 46 patients with BTAI treated with TEVAR at McGill University from 2002 to 2025. Data collected included demographics, associated injuries, Society for Vascular Surgery (SVS) grade, aortic zone, procedural details, and outcomes. Follow-up consisted of serial computed tomography imaging and clinical assessment. Survival and reintervention rates were analyzed.

Median age was 43.5 years (range 16-89 years), with 73.9% male. Most injuries were SVS grade III (78.3%) and located in zones 2 and 3 (65.2% and 26.1%). Median time to repair was 11 hours; 82.6% underwent TEVAR within 24 hours. Males had larger proximal aortic diameters and received larger stent grafts, while oversizing percentages were similar between sexes. Device selection evolved over time, reflecting greater availability of low-profile grafts. Left subclavian artery coverage was performed in 60.9% of patients without long-term sequelae. Immediate complications occurred in 6.5%, all related to femoral access, with no strokes, paraplegia, or 30-day mortality. Over a median follow-up of 116 months (9.6 years), long-term aorta-related mortality was 0%, while non aorta-related mortality was 10.9%. Kaplan-Meier analysis demonstrated overall survival of 100%, 97.6%, and 90.8% at 1, 3, and 10 years, respectively.

TEVAR is a safe and durable treatment for BTAI, with excellent long-term outcomes. Timely intervention and individualized planning based on aortic anatomy and device selection are critical to optimize survival.