Diameter Changes in Traumatic Aortic Injury: Implications for Stent-Graft Sizing

Abstract

Objectives The aim of this study was to compare aortic diameters from admission computed tomography angiography (CTA) scans to postoperative aortic diameters in patients with traumatic aortic injury (TAI) and evaluate the influence of substantial blood loss on aortic diameter. Methods The aortic databases of two tertiary university centers were retrospectively screened for patients with TAI between February 2002 and February 2019. Concomitant organ injuries, bone fractures, blood loss, and clinical outcomes were evaluated. Aortic diameters were measured in CTA upon admission and were compared with the CTA before discharge at three different aortic levels (mid-ascending, 5 cm distal to the end of the stent graft, and at the celiac trunk level). Results We identified 45 patients, aged 43 (first quartile; third quartile [26; 55]) years with a TAI treated by thoracic endovascular aortic repair. The most frequent cause of TAI was a car accident (n = 24). Concomitant injuries were seen in all but one patient. Bone and pelvic fractures were seen in 40 (89%) and 15 (33%) patients, respectively. Type III aortic injury was present in 25 patients (56%). Increase of aortic diameter after stabilization was +1.7 mm (−0.6 mm; 2.5 mm; p = 0.004) at the mid-ascending aorta, +2.1 mm (0.2 mm; 3.8 mm; p < 0.001) 5 cm distal to the stent graft, and +1.5 mm (0.5 mm; 3.2 mm; p < 0.001) at the celiac trunk level. Conclusion In patients with TAI, the aortic diameter is significantly reduced as compared with the aortic diameter at discharge. The reduction of aortic diameter might be caused by hemorrhagic shock and should be kept in mind for appropriate stent-graft sizing.

A Systematic Review and Meta-Analysis of Aortic Morphological Changes after Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury

“…This discrepancy might be correlated to the aortic elastic force acting against endograft radial force, as well as possibly underestimated aortic diameter in hypotensive patients [8,9,13]. Moreover, the non-stented proximal ad distal aortic segment seemed to dilate but to a lesser degree [8,13,14,16,18].…”

Effect of thoracic endovascular aortic stent diameter on short term mortality in esophageal cancer-associated aortoesophageal fistula

“…Previous article about aortic diameter change after traumatic aortic injury give us a hint of increase of aortic diameter on CTA after hemodynamics stabilization was around + 1.7 to 2.1 mm. (10) AEF/AGF is usually concomitant with hypovolemic status. Stent graft selection should take vasoconstriction into concern.…”