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Mid-term Outcomes of Endovascular Repair for Patients with Blunt Traumatic Aortic Injury
Ali Azizzadeh, MD1, Hunter M. Ray1, Kristofer M. Charlton-Ouw, MD1, Charles C. Miller, PhD2, Sheila M. Coogan, MD1, Anthony L. Estrera, MD1, Hazim J. Safi, MD1.
1University of Texas Health Science Center, Houston, TX, USA, 2Texas Tech University Health Sciences Center - El Paso, El Paso, TX, USA.
OBJECTIVES: Aortic injury is the second most common cause of death after blunt trauma. Thoracic endovascular aortic repair (TEVAR) has been widely adopted as an alternative to open repair for treatment of traumatic aortic injury (TAI). Although significant short term benefits have been demonstrated for patients undergoing TEVAR, longer term follow up data is lacking. The purpose of this study is to evaluate the mid-term outcomes of TEVAR at an urban trauma center.
METHODS: We analyzed prospectively collected data from the institutional trauma registry. Follow up data was gathered from a combination of medical records, imaging, telephone interview, and Social Security Death Index (SSDI). Primary outcomes were in-hospital mortality, stroke, and paraplegia. Secondary outcomes included device related adverse events (rupture, migration, or endoleak), secondary procedures, open conversion, and all cause mortality.
RESULTS: Between 9/2005 and 7/2012, 82 consecutive patients (57 male, mean age 39.5 +/- 20 years, mean ISS 34 +/- 9.5) underwent TEVAR for treatment of TAI. A total of 87 devices were implanted: TAG (n=36), CTAG (n=12) (WL Gore, Flagstaff, AZ); Talent (n=29), Valiant (n=5) (Medtronic, Santa Rosa, CA); TX2 (n=2) (Cook, Bloomington, IN), and other (n=3). Left subclavian artery coverage was required in 32 (39%) patients. The technical success rate was 100%. The rate of in-hospital mortality, stroke, and paraplegia was 4(5%), 2 (2.4%), and paraplegia 0(0%), respectively. The median follow up time was 2.3 years (range of 0 to 7). The availability of follow up data was: SSDI (100%), telephone interview (68%), clinic visit (64%), and imaging (82%). The incidence of device related adverse events was 2 (2.4%). There were 4 secondary procedures; 2 patients underwent a carotid-subclavian bypass and 2 patients had an open conversion for device related complications. Survival was 95% at 30 days, 88% at 1 year, 87% at 2 years, and 82% at 5 years.
CONCLUSIONS: At mid-term follow up, TEVAR is an effective and durable option for the treatment of TAI in properly selected patients. Device related adverse events, secondary procedures, and open conversion is rare. Follow up remains a challenge.
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