Long Term Outcomes of TEVAR for Blunt Thoracic Aortic Injury

Abstract

Objectives

Thoracic Endovascular Aortic Repair (TEVAR) is now the standard of care for management of aortic injury from trauma. Long term outcomes stratified by the severity of the aortic injury are limited.

Methods

This is a single center retrospective analysis of all patients undergoing TEVAR for trauma between January 2008-November 2023. Long term outcomes of mortality and re-intervention were stratified and compared based on the blunt thoracic aortic injury score. Kaplan Meier analysis was used to compute one year and 5-year survival.

Results

A total of 104 patients (age 42 ± 15 years; 72 males; 69%) underwent TEVAR for trauma. Most repairs were for grade 3 (59 patients, 57%) or grade 4 (30 patients, 29%) blunt aortic injuries. The remaining patients included grade 1 (1 patient, 1%), grade 2 (14 patients; 13%). Grade 4 injuries were not associated with higher rate of concomitant neurologic injuries (P = 0.33) or death (P = 0.74). Eighty-seven percent patients had a mean follow up of 4.2 ± 3.3 years. Two patients died due to aortic related causes within 30 days (intra-operative hemorrhage in one patient, graft collapse in one patient who had an unsuccessful exploratory thoracotomy). Overall, one year survival was 92%, and 5-year survival was 88% by Kaplan Meier analysis. Patients with neurologic injury trended toward higher mortality in Kaplan Meier analysis but this was not statistically significant (log rank = 0.22). The grade of injury was not significant for long term survival (log rank = 0.81). Early reintervention was required in 2% patients with none required in long-term. Age>40 (P = 0.17), female sex (P = 0.34) and graft diameter>26 mm (P = 0.41) were not significant for re-intervention. None of the patients experienced endoleaks or spinal cord ischemia.

Conclusions

TEVAR is a durable repair for patients with BTAI requiring no re-intervention after one year follow-up. CT surveillance of TEVAR in setting of trauma should be limited to 1 and 5 years after surgery. Long term survival is not related to severity of BTAI.