In this initial experience, the results of TEVAR did not differ from OR. Long-term follow-up is required to determine the effectiveness of this treatment strategy. Adherence to follow-up imaging protocols is challenging in this patient population. Next generation devices will make TEVAR applicable to a wider range of patients.

SSEP and MEP monitoring were highly correlated only when intraoperative changes were irreversible. Reversible changes were not significantly associated with immediate neurologic deficit. Irreversible changes were significantly associated with immediate neurologic deficit, and the findings were identical for SSEP and MEP in this variable, indicating that the more complex MEP measures do not add further information to that obtained from SSEP. Normal SSEP and MEP findings had a strong negative predictive value, indicating that patients without signal loss are unlikely to awake with neurologic deficit.

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A strong relationship between postoperative serum myoglobin and renal failure suggests a rhabdomyolysis-like contributing aetiology following thoraco-abdominal aortic repair. We postulate a novel mechanism of renal injury for which mitigation strategies should be developed.

We present the case of a 14-year-old girl who sustained a traumatic aortic injury (TAI) after a motor vehicle collision. Due to the severity of her associated injuries, she was not a candidate for open aortic repair. Available options for endovascular repair were very limited due to the small aortic diameter (14 mm). We performed a successful endovascular repair with an off-label use of an iliac limb prosthesis (Excluder, WL Gore, Flagstaff, Ariz). This case demonstrates the utility of an iliac limb prosthesis for endovascular repair of TAI in a child as a bridge to future open conversion.

The use of a STAG produced acceptable mortality, bowel and neurological ischaemic risks. Improved strategies to prevent renal ischaemia before and during repair of TAAA with visceral involvement are needed.

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