TEVAR for Treatment of Blunt Traumatic Aortic Injury, a Single Center Experience
Rajavi S. Parikh, DO, Halim Yammine, MD, Jocelyn K. Ballast, BA, Charles S. Briggs, MD, Tzvi Nussbaum, MD, Gregory A. Stanley, MD, Jeko M. Madjarov, MD, John R. Frederick, MD, Frank R. Arko, III, MD
Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
OBJECTIVES: Blunt trauma aortic injury (BTAI) is the second most common cause of trauma death. It is associated with high mortality both prior to and after presentation. Open repair carries a high mortality. We aim to evaluate our experience with TEVAR in the setting of BTAI. METHODS: This is a single center, retrospective review of patients who underwent TEVAR for BTAI between January 1, 2012 and April 1, 2018. RESULTS: There was a total of 39 patients who were predominantly young (mean age 39.5) Caucasian (64%) males (82%). BTAI grades were 2 (10.3%), 3 (71.8%), or 4 (17.9%). Median time from diagnosis to procedure was 30 hours. Median procedure time was 58.8 mins with minimal contrast (57±28.3 c.c.) and radiation doses. Proximal landing zones were 1 (1/39), 2 (22/39), or 3 (16/39) and 100% of cases were completed with 1 stent graft. The average aortic diameter at landing zone by CTA was 23.3±4.6mm while the average stent graft size was 25.7±4mm. Adjunct procedures included LSA embolization (1/39), carotid-subclavian bypass (2/39), and great vessel snorkels (1/39). Average ICU and hospital stays were 10.4±11.4 days and 19.7±21.5, respectively. In-hospital all-cause mortality was 5.3% (2/39). One death was on POD 4 due to a blossoming traumatic brain injury. The other was in an emergently treated grade 4 injury with severe hypotension and no flow in the aorta distal to the transection. They died on POD 1 likely due to severe reperfusion injury. Procedure related complications included a minor stroke in 1 patient (1/39) on POD 1, access related limb malperfusion in 1 patient (1/39) that required reintervention on POD 0, and an aorto-esophageal fistula in 1 patient that developed more than 3 years after TEVAR and resulted in death. There were no instances of spinal cord ischemia (0/39). In a median follow-up time of 379 days, Kaplan-Meier estimates of survival were 94.9% at 30 days and 92.2% at 3 years. Kaplan-Meier estimates for freedom from reintervention were 97.4% through 3 years. CONCLUSIONS: TEVAR in the setting of traumatic blunt aortic injury is safe and effective even with coverage of LSA. It can be accomplished with only one stent graft, minimal contrast and radiation doses, as well as very low procedure-related stroke, spinal cord ischemia, and mortality.
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