Thoracic Endovascular Repair (TEVAR) for Blunt Traumatic Thoracic Aortic Injury: Long-Term Results.

Abstract

Abstract Background:Blunt traumatic thoracic aortic injury (TAI) is a critical injury with high mortality and an uncertain prognosis. In the last twenty years, thoracic endovascular repair (TEVAR) has become the treatment of choice compared to surgery, as it reduces mortality and morbidity. To date, a few studies evaluated long-term clinical and radiological follow-up of TEVAR for blunt traumatic TAI. The main concerns related to long-term follow-up relate to late endograft-related complications, morphological changes in the aorta and the consequences of life-long surveillance in terms of cumulative radiation dose.Results:Technical success was achieved in 38 procedures (100%). The TEVAR-related mortality rate was 0%. No immediate major complications related to the endovascular procedure were observed. The median duration of diagnostic follow-up was 80 months. A total of 4 procedure-related complications (10.5%) were identified at the follow-up. Three (7.9%) distal infoldings and collapses of the thoracic endoprosthesis and one (2.6%) type Ia endoleak were observed. No thrombosis of the prosthesis, nor signs of aortic pseudocoarctation were identified. No further complications related to endograft (endoleaks, infections, rupture, partial or complete thrombosis) occurred. No changes in the native aorta, stenosis, or increases in the endograft’s diameters were observed. A total of 20 patients (52.6%) underwent MRI-angiography examinations, while a total of 34 patients (89.5%) underwent chest radiographs at the follow-up. In all cases, CT-angiography examinations were performed at the follow-up.Conclusions:The consequences of lifelong surveillance deserve special consideration in younger patients treated with thoracic endovascular repair (TEVAR) for blunt traumatic thoracic aortic injury (TAI). Procedure-related complications were observed within one year of TEVAR, limiting concerns related to the durability of the prosthesis. No morphological changes in the aorta were observed despite long-term follow-up.