Long-Term Durability of TEVAR for Blunt Traumatic Aortic Injury in Young Patients

Blunt traumatic aortic injury (BTAI) is the second leading cause of death in blunt trauma. Thoracic endovascular aortic repair (TEVAR) has replaced open repair as standard treatment; however, long-term durability in young patients remains insufficiently characterized.

We conducted a retrospective cohort study of patients aged 16-35 years who underwent TEVAR for computed tomography (CT)-confirmed BTAI at Hospital Kuala Lumpur between 2008 and 2015. Injury severity was graded according to Society for Vascular Surgery criteria. Imaging was analyzed for repair-site remodeling, ascending aortic enlargement, and CT-derived left ventricular mass. Primary outcomes were overall survival and freedom from aortic reintervention. Secondary outcomes included device-related complications, spinal cord ischemia, hypertension, and sequelae following left subclavian artery coverage.

Eighteen TEVAR procedures were performed for BTAI during the study period; 12 involved patients aged ≤35 years and formed the study cohort. All injuries were grade III pseudoaneurysms. Mean age was 24 years and mean proximal aortic diameter was 21.8 mm. Stent grafts sized 24-28 mm were deployed with 10-20% oversizing. Left subclavian artery coverage was required in 4 patients, with selective revascularization in 1. Median time to intervention was 3 days. Technical success was 100%. Median follow-up was 9 years (range 7-14), with a maximum of 15 years. All patients survived without reintervention. No endoleak, migration, fracture, or aneurysmal degeneration was detected. Repair-site expansion was modest (5-8%), corresponding to 0.1-0.2 mm per year. Ascending aortic growth remained below clinically significant thresholds. Left ventricular mass remained stable in 11 patients; one demonstrated a 9.2% increase without hypertension or symptoms.

TEVAR demonstrated excellent long-term durability in young patients with grade III BTAI. Stable aortic remodeling and absence of reintervention over extended follow-up support TEVAR as definitive management in carefully selected trauma survivors.