Healthy Thoracic Aorta Diameter Growth Slows by Age 60 Years With Persistent Age-Dependent Centerline Elongation Throughout Life

Abstract

Thirty-four patients were identified with repaired BTAI as previously described. All endografts were oversized by 0.05 (group 2, F 2,30 ¼ 2.58; P > .05). Maximum injury diameter was significantly different in group 1 before and after CT scans (t 20 ¼ 2.09; P < .05) but not in group 2 (t 19 ¼ 0.93; P ¼ .36) explained by one technical error. Preoperative healthy aortic diameters were significantly different from endograft size in group 1 (F 2,45 ¼ 15.74; P < .00001) and became nonsignificant on follow-up (F 2,41 ¼ 0.81; P > .05). Group 2 showed no difference between healthy aortic diameter and endograft size both preoperatively (F 2,35 ¼ 3.17; P > .05) and postoperatively (F 2,33 ¼ 0.76; P > .05) but trended toward significance.Conclusions: Exclusion of BTAI with TEVAR appears to promote early aortic remodeling. There was no evidence of residual aortic injury in technically successful repairs. Follow-up imaging suggests that injured aorta regresses to the diameter of the implanted endograft whereas healthy aorta dilates to the endograft. This further supports the theory that endografts serve as a bridge to aortic healing in BTAI and long-term seal is not necessary.

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

“…Over time, the diameter of the native aorta gradually increased. This phenomenon was observed by Endicott et al, who found that the aortic diameter increased by 0.1 mm/year in adults from 20 years age to 80 years of age [29]. It appears that post-TEVAR in patients with previously healthy aorta this process is accelerated.…”

“…By synthesizing the findings through a meta-analysis of individual studies, we aimed to gather evidence on the extent of aortic diameter changes, both in the short and long term, following TEVAR in the management of BTAI Our metanalysis demonstrated that the proximal neck and distal neck diameter overall, changes by around 2.5mm, comparing pre and post-intervention imaging. This corresponded with a 10% increase in the proximal aortic neck with respect to normal aortic diameter in the same group of age [29]. Even though these studies reported an intended oversized greater than 10%.…”