Blunt traumatic thoracic aortic injuries: a retrospective cohort analysis of 2 decades of experience

Abstract

OBJECTIVES The aim of this study was to analyse and report the changes in the management of blunt traumatic aortic injuries (BTAIs) in a single centre during the last 2 decades. METHODS A retrospective analysis of all patients diagnosed with BTAI from January 1999 to January 2020 was performed. Data were collected from electronic/digitalized medical history records. RESULTS Forty-six patients were included [median age 42.4 years (16–84 years), 71.7% males]. The predominant cause of BTAI was car accidents (54.5%, n = 24) and all patients presented with concomitant injuries (93% bone fractures, 77.8% abdominal and 62.2% pelvic injuries). Over 70% presented grade III or IV BTAI. Urgent repair was performed in 73.8% of patients (n = 31), with a median of 2.75 h between admission and repair. Thoracic endovascular repair (TEVAR) was performed in 87% (n = 49), open surgery (OS) in 10.9% (n = 5) and conservative management in 2.1% (n = 1). Technical success was 82.6% (92.1% TEVAR, 79% OS). In-hospital mortality was 19.5% (17.5% TEVAR, 40% OS). Of these, 3 died from aortic-related causes. Seven (15.2%) required an early vascular reintervention. The median follow-up was 34 months (1–220 months), with 19% of early survivors having a follow-up of >10 years. Only 1 vascular reintervention was necessary during follow-up: secondary TEVAR due to acute graft thrombosis. Of the patients who survived the initial event, 6.7% died during follow-up, none from aortic-related causes. CONCLUSIONS Even with all the described shortcomings, in our experience TEVAR for BTAI proved to be feasible and effective, with few complications and stable aortic reconstruction at mid-term follow-up. With the current technical expertise and wide availability of a variety of devices, it should be pursued as a first-line therapy in these challenging scenarios.

Longer-term rates of survival and reintervention after thoracic endovascular aortic repair (TEVAR) for blunt aortic injury: a retrospective population-based cohort study from Ontario, Canada

“…A particular challenge in studying the longer-term course of endovascular interventions like TEVAR relates to high rates of lost to follow-up, particularly in young and otherwise healthy patients. The issue compounds over time as patients’ overall health continues to improve and they become increasingly less inclined to return for follow-up visits and surveillance imaging 25 26. As noted in several studies above, loss to follow-up rates of 30%–40% are not uncommon in this patient population, and some studies have reported that 37.6% of TEVAR-treated patients do not return for stent surveillance imaging 29.…”

“…Although limited by a loss to follow-up rate of 41%, they reported a 9.1% rate of death and only two minor endoleaks during the follow-up period 25. Prendes et al 26 followed 46 TEVAR patients for a median duration of 34 months, reporting a 93.3% survival rate and a 2.1% rate of late interventions. However, this study was also limited by a loss to follow-up rate of 43.2% 26…”

“…Prendes et al 26 followed 46 TEVAR patients for a median duration of 34 months, reporting a 93.3% survival rate and a 2.1% rate of late interventions. However, this study was also limited by a loss to follow-up rate of 43.2% 26…”

Endovascular repair of traumatic aortic dissection: a single-center experience

“…EVAR has been the first-line treatment for TAI according to the guidelines of the Society for Vascular Surgery (SVS) [2], the European Society of Cardiology [9], the Eastern Association for the Surgery of Trauma [10], and the European Society for Vascular Surgery (ESVS) [1], considering previously published reports of the low mortality and morbidity of EVAR compared with open surgery. Several studies including a relatively large number of cases with a long follow-up showed satisfactory outcomes of EVAR for TAI and superiority of EVAR over open surgery [3,5,6,[11][12][13]. However, EVAR for TAD was scarcely reported, and the characteristics of TAD were not thoroughly known.…”

Traumatic blunt thoracic aortic injury: a 10-year single-center retrospective analysis

“…Blunt aortic injury is most commonly observed after a sudden deceleration, usually in a car accident. Other causes include motorcycle, aircraft, car, and pedestrian collisions; falls; and crush injuries (5,6,7,8). Approximately 80% of patients died before hospital arrival, and most of the deaths occurred within the rst hour of hospital arrival (2,3,9).…”