Long-term outcomes of thoracic endovascular aortic repair

Brenner, Megan; Teeter, William; Hadud, Muhammed; Hoehn, Melanie; O’Connor, James V.; Stein, Deborah M.; Scalea, Thomas M.

doi:10.1097/ta.0000000000001365

Cited by 27 publications

(22 citation statements)

References 19 publications

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“…In evaluating the data available, the outcomes at our center (LOS, mortality, and endoleak rate) seem comparable with other experiences. 9 The most apparent discovery from the evaluation of this data was the lack of long-term follow-up. Almost 50 per cent of patients made their first scheduled follow-up and three quarters of them received appropriate screening imaging.…”

Section: Discussionmentioning

confidence: 96%

Improving Surveillance of Traumatic Thoracic Aortic Injuries Repaired with Thoracic Endovascular Graft Placement

Ludwig

Bhutiani

Linsky

et al. 2018

The American Surgeon™

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The optimal follow-up protocol for patients undergoing thoracic endovascular aortic repair (TEVAR) for traumatic thoracic aortic injury remains unclear. The objective of this study was to assess follow-up patterns in such patients and present an approach to improve long-term follow-up in this cohort. The University of Louisville Trauma Registry was queried for patients who underwent TEVAR for traumatic thoracic aortic injuries between 2006 and 2016. Demographic, injury-specific, perioperative, and outcome measures were recorded for each patient. Follow-up evaluation and duration of follow-up were captured. Follow-up imaging was reviewed for any evidence of vascular complications. A total of 56 patients underwent TEVAR for traumatic thoracic aortic injury. Median age was 48 (range 18–86). Injury mechanism was largely blunt trauma (55 (98%)). Median injury severity score was 34 (range 17–43). Median length of stay was 12.5 days (range 1–40 days), and 51 patients (91%) survived to discharge. Of these, 30 (54%) made at least one follow-up appointment, and 21 of those 30 (70%) received a follow-up CT scan. Median time to last follow-up was one month (range 0–48 months), with 12 patients (21%) having follow-up beyond two months. No patients demonstrated any evidence of vascular complications on imaging at last follow-up. Despite the increased use of TEVAR to treat traumatic aortic injuries, limited follow-up data exist to predict the long-term outcomes of such interventions. Development of statewide or regional databases may help better track outcomes and identify late complications.

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Section: Discussionmentioning

confidence: 96%

Improving Surveillance of Traumatic Thoracic Aortic Injuries Repaired with Thoracic Endovascular Graft Placement

Ludwig

Bhutiani

Linsky

et al. 2018

The American Surgeon™

View full text Add to dashboard Cite

show abstract

“…Hemodynamic collapse is associated with a smaller-sized aorta compared to normal hemodynamics. 2) We also used 15% oversizing in relation to the aortic diameter at the attachment site, which led to a good result without device collapse.…”

Section: Discussionmentioning

confidence: 99%

Fenestrated Endovascular Repair with Debranching Technique for Blunt Traumatic Isthmus Injury

Morisaki

Sohgawa

Fujii

et al. 2018

Annals of Vascular Diseases

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Thoracic endovascular repair (TEVAR) is a safe treatment alternative to open repair for blunt traumatic aortic injury (BTAI). A 29 year-old-female had multiple traffic injuries, including BTAI located in lesser curve of the isthmus close to the left common carotid artery with an isolated left vertebral artery. TEVAR with simple covering of the left subclavian artery was not adequate to prevent the endoleak. We considered fenestrated TEVAR with RELAY® PLUS to ensure blood flow to the left common carotid artery and reconstruction of the left isolated vertebral and left subclavian artery. The fenestrated TEVAR with a debranching technique provided good results without device-related complications.

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“…However, long-term outcomes of TEVAR in trauma patients are largely unknown. Brenner et al suggested from their long-term outcome data that TEVAR is a feasible treatment modality for BTAI, and it may be at least comparable to open repair [ 14 ]. In a comprehensive meta-analysis review, Murad et al reported the mortality rates of patients who were treated with TEVAR, open repair, and nonoperative medical management to be 9%, 19%, and 46%, respectively ( p < 0.01) [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Using BTAI patient data from a multicentre trial, Khoynezhad et al reported that an aortic injury-related cause of early death was haemothorax [ 16 ]. Brenner et al reported in the long-term outcomes of TEVAR that overall mortality was due to sepsis, cardiac arrest, liver injury, and traumatic brain injury [ 14 ]. Approximately 25% of patients presenting with acute type B aortic dissection are complicated at admission by malperfusion syndrome or haemodynamic instability, resulting in a high risk of early death if untreated [ 17 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR

Wada

Hayakawa

Kanayama

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundBlunt thoracic aortic injury (BTAI) is associated with a high mortality rate and the paradigm of treating patients with BTAI currently favours thoracic endovascular aneurysm repair (TEVAR) if possible. In BTAI, lethal malperfusion caused by a pseudoaneurysm has rarely been reported. We present the first report of a successful case in which a pseudoaneurysm causing the infrequent occurrence of lethal malperfusion and subsequent acute severe ischaemia in the distal portion of the thoracic descending aorta was overcome by veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a bridging therapy until the initiation of TEVAR.Case presentationAn adult woman was transferred to our emergency room after injuries sustained by falling from height. Her vital signs were unstable on admission. CT examination revealed the multiple injuries: traumatic subarachnoid haemorrhage, severe unstable pelvic fracture, and a grade III injury of the thoracic aorta. We made the decision to perform TEVAR after external fixation and transcatheter arterial embolization (TAE) for the pelvic injury. During preparations for TEVAR, her lower limbs rapidly felt cold, and her blood lactate level and serum potassium rapidly increased. By the clinical data and ultrasonography and lower extremity Doppler, we diagnosed severe ischaemia in distal portion of the descending aorta caused by a pseudoaneurysm proximal to the descending thoracic aorta. Because we still had not prepared for TEVAR, we immediately started VA ECMO until TEVAR could begin. After the initiation of VA ECMO, her lactate and potassium levels could be controlled. Under VA ECMO support, she underwent TEVAR. After inpatient rehabilitation, she was discharged home without neurologic sequelae.ConclusionsVA ECMO could be an important, less-invasive treatment as a bridging therapy for acute severe malperfusion syndrome until TEVAR is initiated for BTAI.

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Long-term outcomes of thoracic endovascular aortic repair

Abstract: Prognostic/epidemiologic study, level IV; therapeutic study, level V.

Cited by 27 publications

References 19 publications

Improving Surveillance of Traumatic Thoracic Aortic Injuries Repaired with Thoracic Endovascular Graft Placement

Improving Surveillance of Traumatic Thoracic Aortic Injuries Repaired with Thoracic Endovascular Graft Placement

Fenestrated Endovascular Repair with Debranching Technique for Blunt Traumatic Isthmus Injury

A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR

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