Back to 2025 Karmody Posters
Outcomes Of Proximal Landing Zone Use For Thoracic Endovascular Repair Of Blunt Traumatic Aortic Injuries
Eileen Lu, MD
1, Joseph Dubose
2, Ali Azizzadeh
1, Donald Baril
1, Navyash Gupta
1, Elizabeth Chou
1, Cassra Arbabi
1.
1Cedars-Sinai Medical Center, Los Angeles, CA, USA,
2UT Austin, Austin, TX, USA.
Objective Surgical management of blunt traumatic aortic injuries (BTAI) has shifted towards thoracic endovascular aortic repair (TEVAR) in contemporary series. Existing device guidelines recommending a minimum left subclavian artery seal distance of 20 mm have been derived from studies treating aneurysmal disease. Therefore, our objective was to assess outcomes of patients with BTAI who underwent TEVAR with shorter proximal landing zones under 20 mm.
Methods The Aortic Trauma Foundation is an international, prospective, multicenter registry that was used to examine demographics, injury characteristics, management and outcomes of patients with BTAI who underwent TEVAR from 2016 to 2024 and stratify by landing zone distance.
Results The cohort comprised of 389 patients who underwent TEVAR (270 patients with landing zone < 20 m, 119 patients with landing zone > 20 mm). Patients with landing zones <20mm had a higher proportion of sacral fracture (13.7% vs 4.2%, p=0.009) and pelvic fracture (35.9% vs 25.2%, p=0.05) compared to patients with landing zone >20 mm. Patients with longer landing zones had a greater mediastinal hematoma depth on imaging (26.9 vs 32.3, p=0.04). Unsurprisingly patients with shorter landing zones had a greater proportion of LSCA coverage (42.2% vs 13.8%, p=0.0001) and longer fluoroscopy time (13.3 vs 10.5 minutes, p=0.003). Aortic arch type II was more common in patients with longer landing zones (32.8% vs 19.6%, p=0.007). There was no difference in rates of bovine arch anatomy, native aortic diameters, device coverage length or diameter, or circumferential percentage of injury between landing zone cohorts. There was no difference in any complications including stroke, spinal cord ischemia, upper extremity ischemia, pulmonary, cardiac or renal complications. There was also no difference in reinterventions, device-related or access-related complications. Mortality and length of stay was similar between the cohorts.
Conclusions Patients with BTAI who underwent TEVAR and had proximal landing zones less than 20 mm had similar rates of complications and mortality compared to patients with landing zones greater than 20 mm. A shorter landing zone may be safe and feasible for maintaining a patent LSCA in BTAI and avoiding morbidity of coverage with or without revascularization.
Back to 2025 Karmody Posters
