Outcomes of endovascular repair for patients with blunt traumatic aortic injury

Ali Azizzadeh, Hunter M Ray, Joseph J Dubose, Kristofer M Charlton-Ouw, Charles C Miller, Sheila M Coogan, Hazim J Safi, Anthony L Estrera
Journal of Trauma and Acute Care Surgery 2014, 76 (2): 510-6

BACKGROUND: Traumatic aortic injury (TAI) remains a leading cause of death after blunt force. Thoracic endovascular aortic repair (TEVAR) has been widely adopted as an alternative to open repair for the treatment of TAI. Although significant short-term benefits have been demonstrated for patients undergoing TEVAR, longer-term follow-up data are lacking.

METHODS: Trauma registry data were analyzed. Follow-up data were gathered from a combination of medical records, imaging, telephone interviews, and Social Security Death Index. Primary outcomes were in-hospital mortality, stroke, and paraplegia. Secondary outcomes included device-related adverse events (rupture, migration, or endoleak), secondary procedures, open conversion, and all-cause mortality.

RESULTS: Between September 2005 and July 2012, 82 consecutive patients (57 males, mean [SD] age, 39.5 [20] years; mean [SD] Injury Severity Score [ISS], 34 [9.5]) underwent TEVAR for TAI. A total of 87 devices were implanted: TAG (n = 36), CTAG (n = 12) (WL Gore, Flagstaff, AZ); Talent (n = 29), Valiant (n = 5) (Medtronic, Santa Rosa, CA); TX2 (n = 2) (Cook, Bloomington, IN); and other (n = 3). Left subclavian artery coverage was required in 32 patients (39%). Technical success rate was 100%. Rates of in-hospital mortality, stroke, and paraplegia were 5.0%, 2.4%, and 0%, respectively.Median follow-up time was 2.3 years (range, 0-7 years). The availability of follow-up data was as follows: Social Security Death Index (100%), telephone interview (68%), clinic visit (61%), and imaging (82%). The incidence of device-related adverse events was 2.4%. There were four secondary procedures: two patients underwent a carotid-subclavian bypass, and two had an open conversion for device-related complications. Survival was 95% at 30 days, 88% at 1 year, 87% at 2 years, and 82% at 5 years.

CONCLUSION: At midterm follow-up, TEVAR is an effective and durable option for the treatment of TAI in properly selected patients. Device-related adverse events, secondary procedures, and open conversion are rare. Follow-up remains a challenge.

LEVEL OF EVIDENCE: Therapeutic study, level V.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"