Traumatic Thoracic Aorta Injuries: Outcomes up to 15 years Post Thoracic Endovascular Aortic Repair

Authors

  • Varun J Sharma MBBS/BMedSci

DOI:

https://doi.org/10.26676/jevtm.v4i1.105

Keywords:

Keywords: Trauma, Aorta, Endovascular, Stent

Abstract

Background

Aortic injuries are one of the leading causes of death following trauma, with a 75% pre-hospital and 50% in-hospital mortality. Endovascular repair is technically easier with fewer complications, but unproven in the long term.

Methods

Retrospective analysis of patients who underwent endovascular repair of thoracic aortic injuries from 2001-2018 at Liverpool Hospital. Primary endpoint was death, secondary endpoints were re-interventions, hand ischemia, access vessel repair, cardiopulmonary, neurological and ischemic complications.

Results

24 patients, 10 female, most common mechanism was motor-vehicle injuries (75%) in Zone 3 (71%). Deployment was proximal (n=11), on (n=2) or distal (n=11) to the Left Subclavian Artery (LSCA). Average follow up 5.4 years ±5.1 years (Range 0.1-15.2 years), with 2 deaths. At <90 days, complications were hand ischemia (n=4, n=1 needing intervention), access vessel endarterectomy (n=1) and conversion to open bypass (n=1).  At >90 days, complications were hand ischemia needing intervention (n=1), bird-beaking (n=2) and minor graft thrombosis (n=1). Type I endoleak was the only statistically significant predictor of reintervention (RR 21.00, p=0.002) and hand ischemia (RR 4.7, p=0.02). Survival free from any complication in Zone 2 was 50% at less than 5 years; Zone 3 was 58.8% at 5 years, 42.9%at 10 and 15 years; Zone 4 was 100% at 5 years.

Conclusions

Endovascular repair for thoracic aortic injuries has low levels of mortality and morbidity. The LSCA can be covered without arm ischemia, and Type I endoleak carries high morbidity. At up to 15 years follow up, graft complications remain low. 

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Published

2020-04-07

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Original Article