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Value-Based Approach to Stent-Graft Inventory Selection for Blunt Thoracic Aortic Injury: Multi-Center,
Fiorella Yep Mendizabal1, Alexandra MacHugh1, Joshua Crapps1
1Dell Seton Medical Center at The University of Texas, Austin, TX.
Insights
A limited inventory of six thoracic stent-graft configurations can successfully treat over 90% of blunt thoracic aortic injury (BTAI) cases. This optimization reduces costs and logistical challenges for trauma centers performing thoracic endovascular aortic repair (TEVAR).
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.
Background:
Thoracic endovascular aortic repair (TEVAR) is the standard treatment for blunt thoracic aortic injury (BTAI), but maintaining extensive thoracic stent-graft inventories is costly and logistically challenging. We evaluated whether a limited, anatomy-based inventory could accommodate most BTAI repairs.
Study Design:
The Aortic Trauma Foundation registry was queried for patients with BTAI undergoing TEVAR at 52 trauma centers worldwide from January 2012 to January 2024. Patients with documented initial computed tomography aortic measurements, stent-graft manufacturer, and device size were included. Stent-grafts were ranked by utilization frequency within each manufacturer to determine the minimum number of configurations required to treat at least 90% of patients.
Results:
Among 346 patients, 80% were male and mean age was 41 ± 15 years. Device utilization was greatest for Gore (60%), followed by Medtronic (21%), Cook (12%), and Terumo (6%). Although each manufacturer offered more than 20 thoracic stent-graft options, the six most frequently used configurations treated 91-97% of patients across manufacturers and spanned proximal diameters of 21-32 mm. Of 36 patients (10%) requiring devices outside these configurations, 83% still underwent repair using proximal diameters within the 21-32 mm range. Only 7 patients (2%) required proximal diameters >32 mm; these patients were older (73.6 versus 41 years) and had larger native aortic diameters. Overall, proximal diameters of 21-32 mm encompassed 98.3% of repairs. BTAI grade, endoleak repair rates, and in-hospital mortality did not differ among manufacturers.
Conclusions:
Six stent-graft configurations spanning proximal diameters of 21-32 mm accommodate more than 90% of BTAI TEVAR procedures, while only 2% of patients require larger devices. These findings support evidence-based inventory optimization for trauma centers establishing or maintaining TEVAR capability.