Predictors Associated With Aortic Undersizing In Tevar For Blunt Thoracic Aortic Injury
Isaiah S. Chandra, Vishruth Thaghalli Sunil Kumar, Alexis Peters, Todd R. Vogel, Jonathan Bath, Naveen Balasundaram.
University of Missouri, Columbia, MO, USA.
OBJECTIVES: TEVAR has become standard of care management for cases with Blunt Thoracic Aortic Injury (BTAI) requiring intervention. Correct sizing requires careful balancing of underestimation of normal aortic size at the time of hypotensive trauma versus risks of oversizing in a damaged aorta. The goal of this study was to assess factors affecting accurate aortic sizing during trauma
METHODS: Patients from a Level 1 trauma registry over a 5-year period who had initial CT-A and follow-up imaging within a 6-month period were included. Univariate analysis was used to identify predictors of significant variations of size between initial and follow-up imaging and ROC analyses were used to define cutoffs. Multivariate logistic regression was then used to analyze these predictors.
RESULTS: 177 patients were identified from the Trauma Registry who had initial and follow-up imaging within a 6-month period. 121 (66%) were male and median age was 48 (SD 19.92). The median difference of aortic diameter between initial and follow-up CT imaging taken at the level of the Left Common Carotid Artery (Ad) was 0.65mm. 41 patients (23.2%) were hypotensive and 57 patients (32.2%) had clinically significant difference of 1.5mm in their Ad. Lower age (Odds Ratio OR 0.98, 95% confidence interval CI 0.96 - 0.99), lower respiratory rate on arrival (OR 0.97, 95% CI 0.94 - 1.00), and higher Injury Severity Scale (ISS) (OR 1.04, 95% CI 1.01 - 1.07) were associated with significant difference in aortic diameter. ROC analyses were then used to obtain cutoffs of age < 35, respiratory rate < 20 and ISS > 21. Multivariate logistic regression showed that age < 35 (OR 2.23, 95% CI 1.06 - 4.71), penetrating injury (OR 4.56, CI 1.04 - 20.06), and ISS >21 (OR3.37, 95% CI 1.58 - 7.18) were associated with differences in aortic lumen more than 1.5mm were associated with changes in aortic lumen more than 1.5mm.
CONCLUSIONS: The aortic diameter for patients undergoing TEVAR for thoracic aortic injury may be underestimated in patients presenting with severe trauma. Slight oversizing relative to the initial CT scan should be considered for younger patients who have increased ISS on arrival.
| Variable | OR | p-value |
| Age <35 | 2.234 | 0.034 |
| Penetrating (ref blunt) | 4.563 | 0.044 |
| Respiratory Rate >20 | 0.360 | 0.01 |
| Injury Severity Scale (ISS) > 21 | 3.366 | 0.002 |
| Emergent OR | 0.163 | 0.002 |
| C-statistic | 0.769 | |
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