Endovascular Versus Open Repair for Blunt Thoracic Aortic Injury: Short-Term Results

Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: A systematic review and meta-analysis

“…This was significantly increased to 4.7% (19 of 402) after TEVAR with coverage of the LSA and no preoperative revascularization (POR, 2.28; 95% CI, 1.28-4.09; P ϭ .005; Fig 1). 6,9,11,12, There was no evidence of heterogeneity (Cochran Q, 21.69; P ϭ .91) or bias (Egger, 0.29; P ϭ .22). Despite preoperative revascularization, a significantly elevated risk of perioperative CVA remained (4.1% compared with 2.6%; POR, 3.18; 95% CI, 1.17-8.65; P ϭ .02; Fig 2).…”

“…9,11,12,18,24,25,[36][37][38][39][42][43][44] Fig 3). 6,9,11,12,[14][15][16][17][18][19][20][21][22][23][24][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][45][46][47][48] Again, there was no evidence of heterogeneity (Cochran Q, 10.74; P ϭ .99) or bias (Egger 0.10; P ϭ .50). However, no significant difference was noted in the risk of SCI with LSA coverage and preoperative revascularization compared with no LSA coverage (0.8% vs 2.7%, respectively; POR, 1.69; 95% CI, 0.56-5.15; P ...…”

“…[3][4][5] Furthermore, the technique lends itself well to situations of major trauma, where collateral injury supports the use of a minimally invasive technique. 6,7 The nature of the underlying pathology encountered during TEVAR does, however, mean that the diseased segment of aorta often encroaches upon or involves the aortic arch vessels. Recent series suggest that involvement of zones 0 to 2 of the arch occurs in Ͼ40% of TEVAR cases.…”

Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

“…Early in the experience, patients were selected for TEVAR based on contraindications to open repair for a high a risk of mortality from comorbidity and associated injuries; over time, 11 of 16 centers that described indications broadened the application to all patients with suitable anatomy (6,22,29,31,32,34,36,37,(41)(42)(43)45). In one institution, TEVAR was reserved for those with concomitant brain injury (39).…”

“…Patients were prepared for possible thoracotomy in case of need for open conversion or preprocedural rupture (which occurred in 2.7% of cases) (6,38,39,42). Local anesthesia with conscious sedation was feasible if common femoral access was used (43); however, cutdown under general anesthesia was employed by 92% of investigators. A diagnostic pigtail catheter was placed in the ascending aorta and an angiogram was obtained to confirm the diagnosis and preoperative measurements.…”