Repair Of Traumatic Aortic Injury Research Articles

Postoperative complications of endovascular blunt thoracic aortic injury repair

BackgroundThoracic endovascular aortic repair (TEVAR) has become the standard of care for thoracic aortic aneurysms and increasingly for blunt thoracic aortic injury (BTAI). Postoperative complications, including spinal cord ischemia and...

Antegrade Hybrid Chimney TEVAR Endograft in a Patient with Blunt Aortic Injury: A Challenging Case with Technical Success but Unfavorable Result

Thoracic Endovascular Aortic Repair (TEVAR) has modified aortic medicine, particularly in patients with traumatic aortic injury (TAI). Conventional repair of TAI in the aortic arch is technically demanding as it requires cardiopulmonary bypass and deep hypothermic arrest with still a significant number of complications. Despite recent improvements in endovascular techniques, many patients have been excluded from endovascular repair due to unfavorable anatomy. To increase the feasibility of endovascular repair, adjunctive open extra-anatomical bypasses may be required to provide an adequate proximal landing zone. Several methods, for instance, chimney technique, hybrid technique, and fenestrated or branched stent-grafts, have been proposed as options to preserve the supra-aortic branches, each with its own advantages and disadvantages. We herein present a patient with complex anatomical features and blunt aortic injury, who underwent antegrade chimney stent-graft deployment through the ascending aorta, not otherwise amenable to standard retrograde delivery because of severe peripheral artery disease. The remarkable aspect, in this case, is that both stents were placed antegrade, through the ascending aorta.

TEVAR versus open repair of blunt traumatic descending aortic injury in polytraumatic patients involved in motor vehicle accidents

BackgroundThoracic endovascular aortic repair (TEVAR) is the standard-of-care for treating traumatic aortic injury (TAI). Few retrospective studies compared TEVAR to open repair in blunt traumatic aortic injury (BTAI). Our objectives were to compare the early outcomes of TEVAR for blunt traumatic descending aortic injury to open repair (OR) in polytraumatic patients involved in motor vehicle accidents (MVA).ResultsBetween February 2005 and April 2017, 71 patients with TAI due to MVA presented to our institution. All patients with descending aortic injuries were considered for open repair (n = 41) or TEVAR (n = 30) if there was no contraindication. The primary outcome was mortality, and secondary outcomes were stroke, paraplegia, intensive care unit (ICU), and hospital stay.The mean age was 28.4 ± 10.1 years in the OR group and 33.3 ± 16.6 years in TEVAR-group (P = 0.13). The injury severity scores were 41 ± 10 in the OR group and 33 ± 17 in the TEVAR group (P = 0.03). Patients in the OR group underwent emergency repair with a mean time of 0.56 ± 0.18 days from arrival. The TEVAR group had a longer time interval between arrival and procedure (2.1 ± 1.7 days, P = 0.001). The OR group had more blood transfusion (24 (58.5%) vs. 8 (27.5%), P = 0.002), renal impairment (6 (14.6%) vs. 1 (5.50%), P = 0.23), and wound infection (21 (51.2%) vs. 3 (10%), P < 0.001). Three TEVAR patients had a perioperative stroke compared to two patients in the OR group (P = 0.64). There was no difference in the mean ICU (6 ± 8.9 vs. 5.3 ± 2.9 days; P = 0.1) or hospital stay (20.1 ± 12.3 vs. 20.1 ± 18.3, P = 0.62) between the two groups. There were four deaths in the OR group and none in the TEVAR group (P = 0.13).ConclusionThe results of TEVAR were comparable with the open repair for traumatic aortic injury with good early postoperative outcomes. TEVAR repair could be associated with lower mortality, blood transfusion, and infective complications. However, the complexity of the injury and technical challenges were higher in the open group.

Endovascular repair of traumatic aortic injury in a 16 month old

Abstract Traumatic injury to the thoracic aorta is rare in children. We present the youngest reported case of traumatic thoracic aortic injury, occurring in a 16 month old (10 kg) male. Management emphases include identification and stabilization of all injuries, blood pressure control, timely repair of the aortic injury, and long-term radiographic follow-up. We demonstrate that endovascular repair at this age is feasible, but considerations such as small vessel diameter and patient growth may limit broad application. Long-term outcomes research in this population is necessary.

Intentional left subclavian artery coverage during thoracic endovascular aortic repair for traumatic aortic injury

Thoracic endovascular aortic repair (TEVAR) is widely used for treatment of traumatic aortic injury (TAI). Stent graft coverage of the left subclavian artery (LSA) may be required in up to 40% of patients. We evaluated the long-term effects of intentional LSA coverage (LSAC) on symptoms and return to normal activity in TAI patients compared with a similarly treated group whose LSA was uncovered (LSAU). Patients were identified from a prospective institutional trauma registry between September 2005 and July 2012. TAI was confirmed using computed tomography angiography. The electronic medical records, angiograms, and computed tomography angiograms were reviewed in a retrospective fashion. In-person or telephone interviews were conducted using the SF-12v2 (Quality Metrics, Lincoln, RI) to assess quality of life. An additional questionnaire was used to assess specific LSA symptoms and the ability to return to normal activities. Data were analyzed by Spearman rank correlation and multiple linear and logistic regression analysis with appropriate transformations using SAS software (SAS Institute, Cary, NC). During the study period, 82 patients (57 men; mean age 40.5 ± 20 years, mean Injury Severity Score, 34 ± 10.0) underwent TEVAR for treatment of TAI. Among them, LSAC was used in 32 (39.5%) and LSAU in 50. A group of the LSAU patients (n = 22) served as matched controls in the analysis. We found no statistically significant difference in SF-12v2 physical health scores (ρ = -0.08; P = .62) between LSAC and LSAU patients. LSAC patients had slightly better mental health scores (ρ = 0.62; P = .037) than LSAU patients. LSAC patients did not have an increased likelihood of experiencing pain (ρ = -0.0056; P = .97), numbness (ρ = -0.12; P = .45), paresthesia (ρ = -0.11; P = .48), fatigue (ρ = -0.066; P = .69), or cramping (ρ = -0.12; P = .45). We found no difference between groups in the ability to return to activities. The mean follow-up time was 3.35 years. Six LSAC patients (19%) died during the follow-up period of unrelated causes. Intentional LSAC during TEVAR for TAI appears safe, without compromising mental or physical health outcomes. Furthermore, LSAC does not increase the long-term risk of upper extremity symptoms or impairment of normal activities.

Five-year experience with the peri-operative goal directed management for surgical repair of traumatic aortic injury in the eastern province, Saudi Arabia.

Context:Traumatic aortic injury (TAI) accounts for 1/3 of all trauma victims.Aim:We aimed to investigate the efficacy of the adopted standardized immediate pre-operative and intra-operative hemodynamic goal directed control, anesthetic technique and organs protection on the morbidity and mortality in patients presented with TAI.Settings and Design:An observational retrospective study at a single university teaching hospital.Materials and Methods:Following ethical approval, we recruited the data of 44 patients admitted to the King Fahd Hospital of the University, Al Khobar, Saudi Arabia, with formal confirmation of diagnosis of blunt TAI during a 5-year period from February 2008 to April 2013 from the hospital medical records.Statistical Analysis:descriptive analysis.Results:A total of 44 victims (41 men, median (range) age 29 (22-34) years) with TAI who underwent surgical repair were recruited. Median (range) post-operative chest tube output was 700 (200-1100) ml necessitated transfusion in 5 (11.4%) of cases. Post-operative complications included transient renal failure (13.6%), pneumonia (6.8%), acute lung injury/distress syndrome (20.5%), sepsis (4.5%), wound infection (47.7%) and air leak (6.8%). No patient developed end stage renal failure or spinal cord injury. Median intensive care unit stay was 6 (4-30) days and in-hospital mortality was 9.1%.Conclusion:We found that the implementation of a standardized early goal directed hemodynamic control for the peri-operative management of patients with TAI reduces the post-operative morbidity and mortality after surgical repair.

Acute Traumatic Thoracic Aortic Injury: Considerations and Reflections on the Endovascular Aneurysm Repair.

Traumatic rupture of the thoracic aorta is a life-threatening lesion and it occurs in 10 to 30% of fatalities from blunt thoracic trauma and is the second most common cause of death after head injury. Immediate surgery is often characterized by a high mortality and morbidity rate. Delayed repair of traumatic aortic injuries has significant survival benefits and a much lower mortality rate compared with early open repair. Despite developments in operative techniques, there still remains considerable operative mortality and morbidity associated with a surgical approach even if delayed. Endovascular stent grafts for the thoracic aorta represents an alternative to the conventional approach for traumatic aortic rupture. Because of the lower invasivity avoiding thoracotomy and use of heparin, endovascular repair can be applied in acute patients without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. However, despite the good deal of convincing evidence for endovascular treatment for thoracic aortic diseases and for traumatic aortic injuries as a valid and efficacious alternative to surgery, several reports show a variety of late complications of thoracic endografts especially for first-generation stent-grafts. In light of this, is the endovascular treatment really safe, efficacious and free from complications in the long term? This manuscript aims to offer a moment of reflection on this important chapter of aortic pathology.

大動脈峡部損傷に対し大動脈ステントグラフト留置を行い，左鎖骨下動脈を閉塞させた1例

症例は32歳の女性。既往にうつ病があり，高所からの墜落にて受傷した。来院時，血圧測定不能のショック状態であった。胸腹部造影CTで大動脈峡部損傷（IIIa），垂直剪断型骨盤骨折（IIIc）を主体とした多発外傷を認めた。胸部大動脈造影を行うと大動脈弓部からは腕頭動脈と左鎖骨下動脈が分岐しており，腕頭動脈から右鎖骨下動脈，右総頸動脈が分岐するとともに左総頸動脈も分岐していた。左椎骨動脈は通常どおり左鎖骨下動脈から分岐していた。胸部仮性動脈瘤は直径30mmで，左鎖骨下動脈分岐直後から下方に突出していたが，造影剤の血管外漏出は認めなかった。左鎖骨下動脈起始から仮性動脈瘤までの距離が短く，ステントグラフト留置に十分なlanding zoneの確保は困難であったことから左鎖骨下動脈の閉塞が必要と判断し，上行大動脈からの血管造影で両側椎骨動脈の十分な血流を確認した上で，左鎖骨下動脈を閉鎖させる形でステントグラフトを留置した。術後，一過性に左上肢の血流障害を認めたものの，徐々に左右差がないレベルにまで改善した。胸部大動脈損傷に対し大動脈ステントグラフト留置術を行う際，両側椎骨動脈の十分な血流が確認できれば左鎖骨下動脈閉塞を考慮することができると考える。

Endovascular Repair of Traumatic Aortic Injury: A Novel Arena in Interventional Cardiology

To assess the feasibility of endovascular repair of traumatic aortic injuries performed by interventional cardiologists in collaboration with cardiothoracic surgeons. Traumatic aortic injury (TAI) represents a significant cause of mortality in trauma patients. Endovascular techniques have recently come into play for the management of TAI and are usually performed by a multidisciplinary team consisting of a thoracic or vascular surgeon and/or interventional radiology. With extensive expertise in catheter-based interventions, interventional cardiologists may have a pivotal role in this important procedure. From January 2009 to July 2011, we reviewed the TAI endovascular repair outcomes performed by a team of interventional cardiologists in collaboration with cardiothoracic surgery at our institution. The charts of these patients were reviewed to collect desired data, which included preoperative, procedural, and follow-up details. Twenty patients were identified in our series. Most of these patients developed TAI from motor vehicle accidents. Technical success for endovascular repair of TAI was achieved in all patients. Two patients developed endoleak, of which one patient required subsequent open repair. Two patients expired in the hospital from coexistent injuries. Our series of endovascular repair for TAI performed by interventional cardiologists with the collaboration of cardiothoracic surgeons showed excellent outcomes. Our experience may give further insight in the collaborative role of interventional cardiology and cardiothoracic surgery for endovascular repair of TAI.

Mid-Term Results of Endovascular Repair for Traumatic Aortic Injury

목적: 외상성 대동맥 손상은 그 빈도가 흔하지 않으며 다른 장기나 골격에 다발성 손상을 동반하는 경우가 많아 치료방법을 결정함에 있어 고려해야 할 점이 많다. The Society of Vascular Surgery(R)의 2010년 guideline에 따르면 외상성 대동맥 손상 환자에서 흉부 혈관내 대동맥 성형술(thoracic endovascular endovascular repair, TEVAR)를 우선적으로 시행할 것을 추천하고 있다. 이에 본원에서 이루어진 시술 결과를 바탕으로 유용성을 알아보고자 한다. 방법: 2008년 7월부터 2011년 8월까지 외상성 대동맥 손상으로 TEVAR를 시행 받은 환자들을 대상으로 대동맥 손상의 형태와 위치, 손상부터 시술까지의 시간, 외상의 중증도 (injury severity score), 합병증 등의 자료를 후향적으로 분석하였다. 총 7명의 외상성 대동맥 손상 환자가 TEVAR를 시행 받았고 그들은 모두 하나 이상의 사지골절과 장기손상을 동반하고 있었다. TEVAR는 모두 응급 상황에서 시행하였고 흉부대동맥 스텐트-도관(thoracic aortic stent graft)를 사용하였다. 이후 정해진 간격으로 컴퓨터 단층 촬영을 하여 추적관찰하였다. 결과: 모든 환자는 grade III의 대동맥 손상이었으며, 동반된 골절로는 늑골골절이 가장 많았고 다양한 사지 골절과장기 손상을 동반하고 있었다. TEVAR는 모든 환자에서 성공적으로 시행되었다. 완료대동맥혈관조영(completion angiography) 상 endoleak은 없었고 대동맥 아치혈관의 혈류도 원활하였다. 입원기간 내 사망은 없었으며 허혈성 척수 손상도 발견되지 않았다. 평균 추적관찰 기간은 30.4 ± 23.9개월이었으며 정기적으로 시행한 컴퓨터 단층촬영상 대동맥 시술부위에 합병증이 관찰된 경우는 없었다. 결론: 본원에서 시행한 외상성 대동맥 손상의 혈관 내 성형술의 결과 및 예후는 우수하였다. 외상성 대동맥 손상 환자에서 다른 장기에 출혈과 손상이 있는 것을 고려하면 혈관 내 성형술은 좋은 치료방법으로 생각된다.

Surgical conversion for intragraft thrombosis following endovascular repair of traumatic aortic injury

We report the case of a 32-year-old man with severe polytrauma, submitted to urgent endovascular exclusion of a posttraumatic thoracic aortic pseudoaneurysm. Two years later, computed tomography scan showed asymptomatic mural atherothrombosis of the aortic stent graft in its middle-distal portion, and the patient was placed on oral anticoagulants. As subsequent computed tomography scan showed progression of the thrombosis, the patient underwent surgical conversion, with stent graft explantation and in situ aortic replacement. Gross examination revealed mural organized thrombosis and a significant infolding of the distal end of the stent graft.

Endovascular Repair of Traumatic Aortic Injury Using a Custom Fenestrated Endograft to Preserve the Left Subclavian Artery

To describe the use of custom fenestrated endografts to preserve left subclavian artery (SCA) flow when requiring coverage during endovascular repair of blunt aortic injury (BAI). A 39-year-old male involved in a motor vehicle accident sustained injuries including intracranial hemorrhage, BAI, and extremity fractures. Immediate neurosurgical intervention was required. Once neurologically stabilized, endovascular repair was performed with a commercially available device modified with a custom fenestration to preserve flow into the left SCA. Serial follow-up CT angiography (CTA) demonstrates satisfactory repair with prograde left SCA flow and no evidence of endoleak. Left SCA coverage is often required for successful endovascular repair of BAI. A subgroup of patients who undergo left SCA coverage will require revascularization. The use of custom fenestrated endografts for preserving left SCA during thoracic endovascular aortic repair (TEVAR) for BAI is an innovative and feasible option in patients who require revascularization.

The anesthetic management of cardiovascular trauma

Although little new has been specifically written in recent years regarding the anesthesia management of cardiovascular trauma, two specific areas have seen recent interest and progress, namely the endovascular management of blunt thoracic aortic trauma and commotio cordis, or sudden death following blunt precordial injury. Endovascular repair of thoracic aortic injury has been shown in multiple studies to have short to medium-term mortality and morbidity advantages over repair via thoracotomy. However, long-term (many years) outcome and the expenses required for long-term follow-up of endovascular repairs remain unknown. The risk of commotio cordis during sports activities has become more known to the general population. Recent studies have indicated a very specific limited time during the upstroke of the T-wave to be the critical time for injury, but specific channel involvement is unclear. Although transesophageal echocardiography diagnosis of aortic trauma is very sensitive and specific, in general, the lack of immediate availability at all times of skilled echocardiographers and the immediate availability of spiral computed tomography scanners in trauma centers limits the use of transesophageal echocardiography as a first-line diagnostic tool. Endovascular repair of traumatic aortic injury is becoming routine. Commotio cordis is being increasingly recognized as a cause of acute post-traumatic sudden death.

The role of echocardiography in the early diagnosis of the complications of endovascular repair of blunt aortic injury

PurposeEndovascular repair of traumatic aortic injury has been associated with severe procedural complications, including endoleaks, coverage of the left subclavian artery, stent collapse, access complications, and questionable durability. Echocardiography has proven to be a valuable tool in the intraoperative detection of these complications. In the current study, we report on the use of echocardiography as an early postoperative diagnostic technique for the evaluation of endovascular stent graft positioning in the intensive care setting. MethodsFrom January 2005 to January 2009, 14 patients who underwent endovascular repair of a blunt aortic injury were admitted in our intensive care unit. Transesophageal and/or transthoracic echocardiography were used as first-line diagnostic tools in the assessment of the endovascular graft position. ResultsTwenty-eight percent of patients (4 of 14) developed a pressure gradient between upper and lower limbs (greater than 50 mm Hg), which presented with persistent hypertension, requiring antihypertensive therapy in high doses and difficult weaning. In all 4 patients, stent graft malposition was identified using echocardiography. The diagnosis was verified by computed tomography and aortography. ConclusionNoninvasive echocardiographic monitoring proved to be a valuable tool in the early diagnosis of postoperative stent graft malalignment. To our knowledge, this is the first time that echocardiography is described in the relevant literature as an early diagnostic technique in this setting.

Endograft Collapse After Thoracic Endovascular Aortic Repair

To provide insight into the causes, timing, and optimal management of endograft collapse after thoracic endovascular aortic repair (TEVAR). A comprehensive review was conducted of all published cases of endograft collapse after TEVAR identified using Medline, Cochrane Library Central, and EMBASE. In total, 32 articles describing 60 patients (45 men; mean age 40.6 ± 17.2 years, range 17-78) with endograft collapse were included. All data were extracted from the articles and systematically entered into a database for meta-analysis. In the 60 cases of endograft collapse, TEVAR had most commonly been applied to repair traumatic thoracic aortic injuries (39, 65%), followed by acute and chronic type B aortic dissections (9, 15%). The median time interval between TEVAR and diagnosis of endograft collapse was 15 days (range 1 day to 79 months). On average, the collapsed endografts were oversized by 26.7% ± 12.0% (range 8.3%-60.0%). Excessive oversizing was reported as the primary cause of endograft collapse in 20%, and a small radius of curvature of the aortic arch was responsible for 48% of the cases. The 30-day mortality was 8.3%, and the freedom from procedure-related death at 3 years after diagnosis of stent-graft collapse was 83.1% for asymptomatic patients compared with 72.7% for patients who had symptoms at diagnosis (p=0.029). Endograft collapse typically occurs shortly after TEVAR, most frequently after endovascular repair of traumatic aortic injury. A high level of suspicion for endograft collapse in the first month after TEVAR, as well as further improvement of current endovascular devices, may be required to improve the long-term outcomes of patients after TEVAR.

Endograft Repair of Traumatic Aortic Injury––A Technique in Evolution: A Single Institution's Experience

Endograft Repair of Traumatic Aortic Injury––A Technique in Evolution: A Single Institution's Experience

Endograft Repair of Traumatic Aortic Injury—A Technique in Evolution

We evaluated a large single center experience of endograft repair of blunt traumatic injury of the thoracic aorta. Traumatic aortic transection is a devastating injury with high morbidity and mortality. Endograft repair of these injuries has reduced the rates of death and paraplegia seen with open surgical treatment in the past. However, endograft repair has been associated with a higher incidence of device related failure. The records of 43 consecutive cases of endograft treatment of traumatic aortic injury from December 2004 to November 2008 were reviewed. Patient demographics, procedure details, and outcomes were recorded. Aortic morphology was analyzed for predictors of device failure. Forty-three patients (32 men) with a mean age of 44 years (range: 17-88) were treated. Primary technical success was 86%. Six proximal endoleaks (14.3%) occurred. Two were repaired with a more proximal cuff, but 3 required explantation and open repair (7%). Mortality in this series was 11.6%, but no death was aorta related. No patient having endograft treatment suffered postoperative paraplegia. Early device failure is associated with sharp angulation of the aorta and shortened distance between the left subclavian artery and the site of injury. Follow-up ranged from 1 to 38 months (mean: 7.4 months). There were no late device failures or complications. Endovascular repair of blunt traumatic aortic injury can be performed with a low morbidity and mortality. Anatomic patterns in the aortic arch appear to be predictive of early device failure. Midterm durability is excellent, but reliable follow-up remains challenging in this group of patients.

Endovascular repair of traumatic aortic injury in a pediatric patient

We present the case of a 14-year-old girl who sustained a traumatic aortic injury (TAI) after a motor vehicle collision. Due to the severity of her associated injuries, she was not a candidate for open aortic repair. Available options for endovascular repair were very limited due to the small aortic diameter (14 mm). We performed a successful endovascular repair with an off-label use of an iliac limb prosthesis (Excluder, WL Gore, Flagstaff, Ariz). This case demonstrates the utility of an iliac limb prosthesis for endovascular repair of TAI in a child as a bridge to future open conversion.

Endovascular treatment of acute traumatic thoracic aortic injuries: A retrospective analysis of 20 cases

We report our 10-year experience in the endovascular treatment of acute traumatic thoracic aorta rupture at the Hospital Clinic. We reviewed 20 patients with an acute traumatic thoracic aorta lesion treated with a thoracic endograft between August 1997 and July 2007. All patients had multi-trauma resulting from high-velocity accidents or accidents with great impact. The diagnosis of aortic injury was made on a clinical basis and conventional imaging, confirmed by computed tomographic angiography. The following parameters were studied: age, sex, type and site of the lesion, type of endovascular graft, endovascular operation time, length of stay in the intensive care unit, length of stay in the hospital, immediate and perioperative complications, and mortality. Follow-up data were recorded, consisting of clinical visits, computed tomographic angiography, and plain chest radiographs at regular intervals (3, 6, and 12 months and every subsequent year). The mean follow-up was 58 months. All endovascular procedures were technically successful, and the mean operating time for the endovascular procedure was 74 minutes (range, 55-130 minutes). We recorded an external iliac lesion during the procedure as an unique immediate complication, and it was corrected by an iliofemoral bypass. The only perioperative death (perioperative mortality rate of 5%) was unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during the follow-up. Postoperative data showed no severe endovascular graft- or procedure-related morbidity. We recorded 2 cases of stent fracture, diagnosed by chest radiograph and computed tomographic angiography, without clinical impact or signs of endoleak. The short- and mid-term results of immediate endovascular repair of traumatic aortic injuries are promising, especially when compared with open surgical treatment, indicating that endovascular therapy is preferable in patients with multi-trauma and traumatic ruptures of the thoracic aorta. Nevertheless, long-term follow-up data are necessary to assess the overall durability of this procedure, considering the young age of these patients. The long-term follow-up results will determine whether endovascular treatment should replace open surgery as first-line therapy in thoracic aortic injuries.

Endovascular Treatment of Traumatic Thoracic Aortic Injuries

Although a large proportion of patients with traumatic thoracic aortic injury die before undergoing definitive repair, those who survive still face ongoing risk of death and morbidity. Endovascular therapy may offer a minimally invasive alternative in the repair of the aortic injury. We reviewed our experience with endovascular repair of traumatic aortic injuries using medical records, imaging studies, and a prospectively maintained endovascular and institutional trauma database. Twenty-two patients underwent thoracic endovascular repair (TEVAR) of traumatic aortic injuries over 44 months. The mean (SD) age was 34+/-12 years and 68% were men. Among the 16 patients registered with our trauma database, the mean Injury Severity Score was 33+/-16 (range, 13 to 45). All injuries were sustained from blunt trauma; 95% of patients had nonaortic thoracic injuries, and 64% and 55% had extremity and abdominal injuries, respectively. Intraoperatively, 91% were repaired under general anesthesia, the mean procedure time was 80+/-52 minutes, and mean blood loss was 219+/-72 mL. The mean fluoroscopy time was 13+/-5 minutes and contrast volume 98+/-23 mL. Twenty-one patients (95%) required coverage of the left subclavian artery to achieve an adequate proximal landing zone. There were no in-hospital or 30-day deaths. The median length of stay was 8 days (range, 1 to 62 days), and 11 (50%) patients were able to be discharged home (versus to another extended care facility). At a mean followup of 7.7 months (range, 0 to 40 months) there were 2 patients (9%) who required endograft-related reintervention at 1 and 6 months. One was an access-related complication, and the second was complete device collapse with acute aortic occlusion, resulting in the patient's death. Although patients who undergo endovascular repair of traumatic thoracic aortic transections typically have significant concomitant injuries, the procedure itself is well tolerated and can be performed rapidly with minimal blood loss and contrast administration. But close followup is necessary given the risk of late complications.