Influence of Thoracic Endovascular Repair on Aortic Morphology in Patients Treated for Blunt Traumatic Aortic Injuries: Long-term Outcomes in a Multicenter Study

Abstract

Listen

Translate article

Introduction - To evaluate long-term outcomes and aortic remodeling in patients treated with thoracic endovascular aneurism repair (TEVAR) for blunt traumatic aortic injuries (BTAI). Methods - From 2004 to 2017 a cohort of 52 patients with BTAI were treated at four Italian trauma centers (Modena, Reggio Emilia, Pisa, Bolzano). This is an observational retrospective multicenter study, measurements and data were reviewed by a single center (Modena) that performed the analysis. The primary endpoint was to evaluate proximal and distal aortic neck remodeling during follow up. Secondary endpoint includes evaluation of each graft-related complication or caused by reiterate radiation exposure. The study protocol required CTA scans within 3 months and at 1, 6 and 10 postoperative years. From 2004 to 2017 a cohort of 52 patients with BTAI were treated at four Italian trauma centers (Modena, Reggio Emilia, Pisa, Bolzano). This is an observational retrospective multicenter study. Primary endpoint was to evaluate proximal and distal aortic neck remodeling during follow up. Secondary endpoint includes evaluation of each graft-related complication or caused by reiterate radiation exposure. The study protocol required CTA scans within 3 months and at 1, 6 and 10 postoperative years. Results - Median age was 46 years [range 20-86], mean oversizing of TEVAR was 19.5% ± 9.7% [range 5%>35%]. At 30-days 47 (90.4%) patients were alive and took part at the study. During a median follow-up of 86 ± 79 months (range, 1-160 months) late survival was 95,7% (n=45/47), no spinal cord ischemia (SCI), endoleak, migration, device rupture and malignancies were recorded and one re-intervention (TEVAR) was performed for a late intramural hematoma on third post-operative month. Freedom from aortic remodeling was 86.5% (SE 4.7%), 53.8% (SE 6.9%) and 51.9% (SE 6.9%) at 1, 6 and 10 years respectively. A significant correlation between time to intervention (proximal and distal: P< .001), age (proximal P< .001; distal P= .002), distal and proximal neck increasing was found. A significant correlation between sealing in zone 2 and increasing in both proximal (P= .027) and distal (P= .042) diameter was found, on the other hand subclavian revascularization seems to have not affected this outcome. A correlation between oversizing and proximal neck diameter remodeling (P=.05) was found to be 3.4% at each 10% oversizing increase. Median age was 46 years [range 20-86], mean oversizing was 19.5% ± 9.7% [range 5%>35%]. At 30-days 47 (90.4%) patients were alive and took part at the study. During a median follow-up of 86 ± 79 months (range, 1-160) late survival was 95,7% (n=45/47), no spinal cord ischemia, endoleak, migration, device rupture and malignancies were recorded and one re-intervention was performed for a late intramural hematoma. Freedom from aortic remodeling was 86.5% (SE 4.7%), 53.8% (SE 6.9%) and 51.9% (SE 6.9%) at 1, 6 and 10 years respectively. A significant correlation between time to intervention, age, distal and proximal neck increasing was found. Correlation between sealing in zone 2 and increasing in both proximal (P= .027) and distal (P= .042) diameter was found. A correlation between oversizing and proximal neck diameter remodeling (P=.05) was found to be 3.4% at each 10% oversizing increase. Conclusion - TEVAR has confirmed to be safe over years but aortic remodeling and oversizing are likely related. We reported a correlation between oversizing and remodeling without an increase of adverse events over time.