Outcomes after thoracic endovascular aortic repair in patients with traumatic thoracic aortic injuries—a single-centre retrospective review

Abstract

Blunt and penetrating traumatic thoracic aortic injuries constitute surgical emergencies that are attended with high mortality rates. Most patients do not survive long enough, post injury, to reach a hospital. On-site mortality rates may approach approximately 85%. Two main treatment options for blunt thoracic aortic injuries are open surgery and thoracic endovascular repair. Penetrating thoracic aortic injuries have a higher mortality than blunt trauma, with patients often only reaching the hospital in extremis. Thoracic endovascular repair is currently rapidly evolving as the standard of care for thoracic aortic injuries at many centres. This is a ten-years retrospective study during which data from December 2006 to December 2016 was collected, yielding 34 patients (30 blunt trauma, 4 penetrating trauma). These injuries were treated with thoracic aortic stent grafts at the Groote Schuur Hospital Vascular Unit, Cape Town. We assessed the technical and clinical outcomes. The 30-day mortality rate was 5.8%, corresponding to 2 deaths both associated with the index trauma-related fatal strokes. The overall mortality rate was 11.8% (4/34): three deaths were due to major strokes and one death was related to pulmonary complications. Thoracic endovascular repair after traumatic aortic injury is associated with significantly lower procedural and post-operative mortality. The 30-day and overall mortality after thoracic endovascular repair in our unit is comparable to international standards. Even though there is a paucity of literature on penetrating traumatic aortic injury, thoracic endovascular repair has low peri-procedural adverse events and is safe in selected patients.