Influence of Thoracic Endovascular Repair on Aortic Morphology in Patients Treated for Blunt Traumatic Aortic Injuries: Long Term Outcomes in a Multicentre Study

• Published in: European journal of vascular and endovascular surgery 2020-03, Vol.59 (3), p.428-436
• Main Authors: Gennai, Stefano, Leone, Nicola, Andreoli, Francesco, Munari, Elisa, Berchiolli, Raffaella, Arcuri, Luciana, Tusini, Nicola, Marcheselli, Luigi, Silingardi, Roberto
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - injuries; Aorta, Thoracic - physiopathology; Aorta, Thoracic - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blunt injury; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular technique; Female; Humans; Italy; Male; Middle Aged; Prosthesis Design; Retrospective Studies; Thoracic aorta; Thoracic Injuries - diagnostic imaging; Thoracic Injuries - physiopathology; Thoracic Injuries - surgery; Time Factors; Treatment Outcome; Vascular Remodeling; Vascular System Injuries - diagnostic imaging; Vascular System Injuries - physiopathology; Vascular System Injuries - surgery; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - physiopathology; Wounds, Nonpenetrating - surgery; Young Adult
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2019.05.008

The aim of this study was to evaluate aortic remodelling and associated complications in patients treated by thoracic endovascular aneurysm repair (TEVAR) for blunt traumatic aortic injuries (BTAI). This was a retrospective, observational, multicentre study. Remodelling was considered as aortic diameter variations of >2 mm and distal graft and aortic axis angle modification measured by computed tomography angiography (CTA). The predefined levels of measurement were the proximal end of the graft (D1: landing in zone [LZ] 2; D2: LZ 3); distal end (D3); and control measurement (D4) 15 mm beyond D3. Survival, procedure, graft, and/or radiation exposure related complications were registered. CTA was required within three months and at one, six, and 10 years post-operatively. Between 2004 and 2017 52 patients were treated; 47 were included for remodelling analysis (five immediate deaths were excluded); median age was 47 years (range 20–80 years). Mean TEVAR oversizing was 19.6% ± 9.7% (range 5%–35%). Following a median follow up of 67.4 ± 56.1 months (range 14–153 months) survival at one, three, six, and 10 years was 90.4% (standard error [SE] 4.1%), 88.3% (SE 4.5%) 84.8% (SE 5.5%), and 84.8% (SE 5.5%), respectively. There were no procedure/graft related complications except for one late intramural haematoma that required re-intervention. Freedom from aortic remodelling at one, six, and 10 years was 85.1% (SE 5.2%), 30.9% (SE 8.6%), and 24.7% (SE 8.8%), respectively. The increase in D1/D2 and D3 diameters were influenced by time from intervention (both p