Long-term Outcomes of Endovascular Repair for Blunt Thoracic Aortic Injury: A 10 Year Multi-center Experience

Mingwei Wu; Zhaoxiang Zeng; Xianhao Bao; Luxia Ren; Jiaxuan Feng; Rui Feng; Jiang Xiong

doi:10.1177/15266028241245326

Long-term Outcomes of Endovascular Repair for Blunt Thoracic Aortic Injury: A 10 Year Multi-center Experience

J Endovasc Ther. 2024 Apr 11:15266028241245326. doi: 10.1177/15266028241245326. Online ahead of print.

Authors

Mingwei Wu¹, Zhaoxiang Zeng², Xianhao Bao², Luxia Ren¹, Jiaxuan Feng², Rui Feng³, Jiang Xiong¹

Affiliations

¹ Department of Vascular and Endovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.
² Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China.
³ Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

PMID: 38605568
DOI: 10.1177/15266028241245326

Abstract

Objective: This study aimed to assess the long-term outcomes in patients treated by thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injuries (BTAI).

Materials and methods: From January 2010 to December 2019, this retrospective observational study was conducted at 3 centers, involving 62 consecutive BTAI patients who underwent TEVAR. Computed tomography angiography scans were planned to be conducted at 6 months post-procedure, and annually thereafter.

Results: Technical success was achieved in all 62 procedures (100%), which included cases of dissection (n=35, 56.45%), pseudoaneurysm (n=20, 32.26%), and rupture (n=7, 11.29%). Mean injury severity score was 31.66±8.30. A total of 21 supra-arch branches were revascularized by chimney technique, with 12 cases involving the left subclavian artery (LSA) and 9 cases involving the left common carotid artery. In addition, 11 LSAs were covered during the procedure. The in-hospital mortality rate was 1.61% (n=1). The mean follow-up time was 86.82±30.58 months. The all-cause follow-up mortality rate was 3.28% (n=2). Stenosis or occlusion of 3 supra-arch branches (4.92%) was identified at follow-up, with 2 cases (3.28%) requiring re-intervention. No spinal cord ischemia, endoleak, or migration was observed.

Conclusions: Despite only including patients with long-term follow-up, this study confirms the long-term safety and effectiveness of TEVAR for BTAI. For young BTAI patients, as the thoracic aorta increases with age, longer follow-up is needed to observe the potential mismatch between the endograft and the aorta.

Clinical impact: This study confirms the long-term safety and effectiveness of endovascular treatment for blunt thoracic aortic injury (BTAI). For young BTAI patients, as the thoracic aorta increases with age, longer follow-up is needed to observe the potential mismatch between the endograft and the aorta. Through a remarkably extended follow-up period (86.82±30.58 months) conducted at multiple centers in China, this study confirms the long-term safety and effectiveness of endovascular treatment for BTAI.

Keywords: blunt thoracic aortic injury; endograft; long-term; multi-center study; thoracic endovascular aneurysm repair.