Abstract
The data on endovascular aortic repair (EVAR) for traumatic aortic dissection (TAD) are lacking. Hence, this study aimed to evaluate the efficacy of EVAR for TAD and report our experience based on patients from our medical center with a relatively long follow-up. A total of 25 consecutive patients with TAD underwent EVAR from October 2015 to October 2020. The demographics, imaging characteristics, clinical features, treatment details, and follow-up results were reviewed. Urgent EVAR was performed in 3 patients (12%), while the remaining 22 patients (88%) underwent delayed EVAR. Systematic heparinization was used in all patients during the endovascular procedure. The EVAR was technically successful in all patients, with no cases converted into open surgery. No death occurred during the perioperative period. One patient presented with a type II endoleak on postoperative 1-month CT images during a mean follow-up of 42.3 ± 17.7 months (5-67.5 months) and showed spontaneous regression of the endoleak without any intervention during the subsequent follow-up. All the patients survived until the time of writing, and none of them showed late endoleak, stent migration, paraplegia, and reintervention. The patients with left subclavian artery covered (n = 8) had no obvious ischemia of the arm and brain. The study results demonstrated that EVAR for TAD proved to be safe and effective, and most patients could undergo delayed EVAR. Systematically heparinization during EVAR under the setting of multi-trauma was safe.
Highlights
Traumatic aortic injury (TAI), including traumatic aortic dissection (TAD) is a potentially lethal clinical event usually seen in high-speed vehicle accidents and falls from heights
Reports on TAD treated by Endovascular aortic repair (EVAR) are limited, which poses a specific concern for its management [7]
Given the lack of data on endovascular repair of TAD, we aimed to evaluate the efficacy of EVAR for TAD and report our experience based on patients from our medical center with a relatively long follow-up
Summary
Traumatic aortic injury (TAI), including traumatic aortic dissection (TAD) is a potentially lethal clinical event usually seen in high-speed vehicle accidents and falls from heights. It is the second leading common cause of trauma-related death. Endovascular aortic repair (EVAR) offers lower perioperative mortality and provides satisfactory outcomes compared with open repair in patients with TAI [5, 6] It has been recommended as the first-line treatment by the 2011 Society for Vascular Surgery clinical practice guidelines and the 2017 European Society for Vascular Surgery Guidelines [1, 2]. Reports on TAD treated by EVAR are limited, which poses a specific concern for its management [7]
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