Value-Based Approach to Stent-Graft Inventory Selection for Blunt Thoracic Aortic Injury: Multi-Center,...

Area of Science:

• Vascular Surgery
• Trauma Management
• Medical Device Optimization

Background:

• Thoracic endovascular aortic repair (TEVAR) is standard for blunt thoracic aortic injury (BTAI).
• Maintaining large stent-graft inventories is costly and logistically difficult.
• Evaluating a limited, anatomy-based inventory for BTAI repairs is crucial.

Purpose of the Study:

• To determine if a limited, anatomy-based inventory of thoracic stent-grafts can accommodate most BTAI repairs.
• To identify the minimum number of stent-graft configurations needed for efficient BTAI treatment.
• To optimize inventory management for trauma centers performing TEVAR.

Main Methods:

• Data from the Aortic Trauma Foundation registry (2012-2024) of BTAI patients undergoing TEVAR were analyzed.
• Stent-graft utilization frequency was ranked by manufacturer to identify essential configurations.
• Inclusion criteria: documented aortic measurements, stent-graft manufacturer, and device size.

Main Results:

• Six stent-graft configurations (21-32 mm proximal diameters) covered 91-97% of patient needs across manufacturers.
• Overall, 98.3% of repairs utilized devices within the 21-32 mm proximal diameter range.
• Only 2% of patients required devices larger than 32 mm, often associated with older age and larger native aortas.

Conclusions:

• A limited inventory of six stent-graft configurations effectively treats over 90% of BTAI TEVAR procedures.
• This approach supports evidence-based inventory optimization for trauma centers.
• Inventory reduction strategies can enhance TEVAR capability without compromising patient care.