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Single Retrograde Thoracic Branch Endoprosthesis Versus Traditional Endovascular Repair With Subclavian Coverage For Treatment Of Blunt Thoracic Aortic Injuries
Kathryn DiLosa, MD, MPH, Diego Anaya, MD, Nicole Weiss, MD, Steven Maximus, MD.
UC Davis, Sacramento, CA, USA.
Objectives: The Gore TAG thoracic branch endoprosthesis (TBE) allows zone 2 thoracic endovascular aortic repair (TEVAR), while maintaining left subclavian artery patency via retrograde sidebranch. We compared zone 2 repair with TBE for blunt thoracic aortic injuries (BTAI) to TEVAR with left subclavian artery (LSA) coverage.
Methods: We retrospectively identified patients with zone 2 repair for BTAI at a single institution. Primary outcome was technical success and incidence of stroke and extremity ischemia. Secondary outcomes were TBE sidebranch patency and procedure related complications, including endoleak, stroke, access complications, and extremity ischemia.
Results: Between 2005-2024, 69 patients had TBE repair, 17 for BTAI, while 153 patients had TEVAR for BTAI, 48 (31%) with zone 2 repair and LSA coverage. TBE cohort mean age was 55 (±20) and Injury Severity Score (ISS) was 29 (±6). Mean age in the TEVAR cohort was 45 (±19) and ISS 38 (±14) (Table I).
In the TBE cohort, 15 patients (93%) had complete percutaneous access (femoral and radial), one patient had percutaneous brachial and one required open femoral exposure. In the TEVAR
cohort, 21 patients (44%) had open femoral exposure (p=.12). Mean distance between the left common carotid and LSA was 18.9 mm (±4), 6 patients had a bovine arch (35%), and 87% (15 of 17 patients) met the indications for use.
Technical success, device delivery with exclusion of injury, was 100% in both groups. In the TEVAR cohort, 9 patients (19%) had LSA revascularization. There were no complications in the TBE cohort. Twelve patients in the TEVAR cohort experienced any complication (0% versus 25%, p=.017) and 5 patients (10%) experienced a stroke or upper extremity ischemia (p=.21). No aortic related mortalities were observed. TBE side branch patency and BTAI exclusion was 100% at mean follow up of 26 days (range 2-107).
Conclusion: TBE offers a safe alternative to TEVAR with LSA coverage in BTAI with zone 2 coverage. A larger cohort is needed to confirm findings.
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| Table I: Patient demographics and aortic pathology |
| Demographics | TBE cohortN (%) | TEVAR cohortN (%) | P value |
| Age (mean ± SD) | 55±20 | 45±19 | p=.06 |
| Male gender | 9 (53) | 32 (67) | p=.21 |
| Hypertension | 6 (35) | 9 (19) | p=.15 |
| History of tobacco use | 3 (18) | 15 (31) | p=.49 |
| COPD | 0 (0) | 1 (2) | p=.74 |
| Coronary artery disease | 1 (6) | 2 (4) | p=.60 |
| History of stroke | 0 (0) | 0 (0) | |
| Aortic Pathology | |
| BTAI Injury Grade (SVS) | | | p=.66 |
| 1 | 0 (0) | 1 (2) | |
| 2 | 1 (6) | 1 (2) | |
| 3 | 15 (88) | 40 (83) | |
| 4 | 1 (6) | 6 (13) | |
| Zone of injury | | | p=.66 |
| 2 | 4 (24) | 17 (35) | |
| 3 | 12 (71) | 31 (65) | |
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