Thoracic Endovascular Aortic Repair for Penetrating Aortic Trauma.

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Thoracic Endovascular Aortic Repair (TEVAR) reduced mortality for blunt aortic injury (BAI) from 30-50% to < 10%; however, penetrating traumatic aortic injury (PAI) remains highly lethal (>40% mortality). This study's goal is to determine outcomes of TEVAR for PAI. Patients undergoing TEVAR for traumatic aortic injuries were identified from the Vascular Quality Initiative database from 2011-2022. Patients with blunt and penetrating injuries were compared based on pre-operative characteristics, injury severity, and post operative outcomes. TEVAR was performed for 1,867 patients with traumatic aortic injuries of which 1808 (96.9%) patients had BAI, and 59 (3.1%) had PAI. The majority of injuries being treated were either grade 3 (pseudoaneurysm) (55.3%) or grade 4 (transection) (16.4%). PAI patients had a higher proportion of grade 4 injuries compared to BAI (36.4% vs. 16.5%, p=0.001). The majority of PAI were in zones 4-5 (61.1% vs. 14.2%, p<0.001), whereas the majority of BAI were in zone 3 (66.5% vs. 16.7%, p<0.001). Overall, the mortality rate was 8.2% (N=154). In hospital mortality was 8.5% in the PAI group and 8.2% in the BAI group (p=0.813). There was no significant difference in major complication rates between PAI and BAI patients. PAI occurs more commonly in zones 4-5 of the thoracic aorta and often presents with higher grade aortic injury when compared to BAI. TEVAR for PAI provides excellent in-hospital survival, especially compared to historical mortality rates around 40%. An endovascular first approach may lead to improved survival for PAI.