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Thoracic Branch Endoprosthesis as Safe Alternative Therapy for Blunt Traumatic Aortic Injury Requiring Zone 2
Rebecca S Meltzer1, Robert C Keskey1, Ibraheem Hamzat2
1Department of Surgery, University of Chicago Medicine, Chicago, IL.
Annals of Vascular Surgery
|May 9, 2026
Summary
Thoracic branch endoprosthesis (TBE) offers a safe and effective alternative for treating zone 2 blunt traumatic aortic injuries (BTAI). This less invasive approach showed non-inferior outcomes compared to traditional TEVAR with debranching, making it a viable option for select patients.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Endovascular Repair
Background:
- Blunt traumatic aortic injury (BTAI) involving the left subclavian artery (zone 2) presents significant management challenges.
- Thoracic branch endoprosthesis (TBE) with a left subclavian artery side branch is a novel endovascular solution for zone 2 TEVAR.
- TBE aims to provide a less invasive alternative for zone 2 BTAI repair.
Purpose of the Study:
- To evaluate the non-inferiority of TBE compared to thoracic endovascular aortic repair with aortic arch debranching (TEVAR-DB) for zone 2 BTAI.
- To compare patient demographics, complications, ICU length of stay, and mortality between TBE and TEVAR-DB.
Main Methods:
- Retrospective analysis of prospectively collected data from the National Trauma Data Bank (2017-2022).
- Inclusion criteria: adult patients (>16 years) undergoing TBE or TEVAR-DB for zone 2 BTAI.
- Comparison of outcomes including stroke, DVT, VAP, ARDS, SSI, unplanned return to OR, ICU-LOS, and mortality using Wilcoxon signed-rank tests and linear regressions (p<0.05).
Main Results:
- 94 patients met inclusion criteria: 61 in the TBE group and 33 in the TEVAR-DB group.
- No significant differences in gender, age, AIS, or ISS between groups.
- TBE group had lower GCS on presentation (p=0.04); however, no significant differences in complications, stroke rate, ICU-LOS, or mortality were observed on multivariate analysis.
Conclusions:
- TBE is a non-inferior treatment option for BTAI requiring a zone 2 seal.
- TBE represents a less invasive alternative for zone 2 BTAI in appropriate patient populations.
- Further research may explore TBE's long-term efficacy and expanded indications.
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