Minimum 10-year follow-up of endovascular repair for acute traumatic transection of the thoracic aorta

Abstract

Thoracic endovascular aortic repair (TEVAR) for traumatic rupture of the descending thoracic aorta seems, in the short term, to be associated with better outcomes than open repair, but long-term data are lacking. A review was conducted of a prospectively maintained database of patients who underwent TEVAR for traumatic rupture of the descending thoracic aorta in our unit, with a minimum 10-year follow-up. Follow-up computed tomography scans were performed at 1 week, 3 and 6 months, and annually thereafter. Particular attention was focused on device-related issues. Among the 53 patients, 17 had a minimum 10-year follow-up: mean age was 45.8 ± 17 years (range: 18-78 years); 4 were women. Mean follow-up was 11.6 years (range: 10.1-13.1 years). Technical success was achieved in 100% of cases. The distribution of the proximal landing zone was zone 2 in 4 cases, zone 3 in 13 cases. A case of inadvertent coverage of supra-aortic trunks occurred intraoperatively. An early proximal type I endoleak was successfully treated by proximal implantation of an additional second stent-graft. No perioperative death was observed, and none of the patients suffered transient or permanent paraplegia, or cerebral complication. After a minimum 10-year follow-up, all patients were still alive. Follow-up computed tomography scans did not reveal any stent-graft migration or collapse, or secondary endoleaks. However, we observed that the proximal and distal aortic neck dilated to some extent, as is the natural history of the thoracic aorta. This dilation was more marked in patients aged <30 years. Our minimum 10-year follow-up study of endovascular repair for acute traumatic transection of the thoracic aorta demonstrated that the reduction in the operative mortality rate of TEVAR, compared with open repair, lasts over time, without any device-related issues. Longer-term follow-up is necessary to determine whether the thoracic aorta expansion continues and becomes clinically significant.