Effective Neck For Endovascular Treatment Of Blunt Traumatic Aortic Injury

Abstract

INTRODUCTION AND OBJECTIVES To identify the proximal neck required for endovascular treatment of blunt traumatic aortic injuries involving the proximal descending thoracic aorta. METHODS The pre-operative and post-operative contrast-enhanced CT scans of patients treated at a single level 1 trauma center between 2005 and 2021 were retrospectively analyzed with Terarecon Aquarius iNtuition software. The distance between the left subclavian artery and the aortic injury was measured at the admission studies and the distance between the LSA and the covered portion of the aortic endograft was measured at follow-up CT scans utilizing straightened centerline reconstructions.Follow-up imaging was also reviewed for presence of endoleak or complications related to the index procedure. Patients treated with Gore TAG Thoracic Branch Endoprosthesis were excluded from the analysis. RESULTS Out of 209 TEVARs performed between September 2005 and January 2021, 54 consecutive patient charts were reviewed, 3 patients were treated with Gore TAG TBE and 16 did not have post-operative CT scans. Median follow-up CT timing was 44 days (IQR 9.5 - 92).Of the 35 patients analyzed, 4 TEVARS were intentionally deployed in zone 2, the remaining grafts were implanted in zone 3 or lower.The median sealing zone was 8mm (IQR 4mm - 13mm). No endoleak was visible at follow-up CT, and only one left subclavian artery occlusion was found in the zone 3 TEVAR sub-group despite lack of LSA ostium coverage at index procedure and follow-up imaging. CONCLUSIONS This retrospective study demonstrates that a short proximal neck is both effective and safe for endovascular treatment of blunt traumatic aortic injuries. These findings can assist in determining the appropriate graft landing zone, avoiding the unnecessary coverage of the left subclavian artery necessary when trying to achieve a neck comparable to that required for atherosclerotic thoracic aortic aneurysms. To identify the proximal neck required for endovascular treatment of blunt traumatic aortic injuries involving the proximal descending thoracic aorta. The pre-operative and post-operative contrast-enhanced CT scans of patients treated at a single level 1 trauma center between 2005 and 2021 were retrospectively analyzed with Terarecon Aquarius iNtuition software. The distance between the left subclavian artery and the aortic injury was measured at the admission studies and the distance between the LSA and the covered portion of the aortic endograft was measured at follow-up CT scans utilizing straightened centerline reconstructions.Follow-up imaging was also reviewed for presence of endoleak or complications related to the index procedure. Patients treated with Gore TAG Thoracic Branch Endoprosthesis were excluded from the analysis. Out of 209 TEVARs performed between September 2005 and January 2021, 54 consecutive patient charts were reviewed, 3 patients were treated with Gore TAG TBE and 16 did not have post-operative CT scans. Median follow-up CT timing was 44 days (IQR 9.5 - 92).Of the 35 patients analyzed, 4 TEVARS were intentionally deployed in zone 2, the remaining grafts were implanted in zone 3 or lower.The median sealing zone was 8mm (IQR 4mm - 13mm). No endoleak was visible at follow-up CT, and only one left subclavian artery occlusion was found in the zone 3 TEVAR sub-group despite lack of LSA ostium coverage at index procedure and follow-up imaging. This retrospective study demonstrates that a short proximal neck is both effective and safe for endovascular treatment of blunt traumatic aortic injuries. These findings can assist in determining the appropriate graft landing zone, avoiding the unnecessary coverage of the left subclavian artery necessary when trying to achieve a neck comparable to that required for atherosclerotic thoracic aortic aneurysms.