Traumatic Aortic Injury Research Articles

Prognostic Value of Serum Albumin in Aortic Aneurysm Patients Undergoing Graft Replacement of Ascending Aorta and Aortic Arch

Background: Hypoalbuminemia is a marker of poor overall health with influences from protein energy malnutrition, systemic inflammation and hepatic and renal disease. Albumin has been reported to have a prognostic impact in various cohorts. This study investigated whether preoperative serum albumin levels could be used to predict mortality in patients with aortic aneurysms undergoing graft replacement of ascending aorta and aortic arch. Methods: We retrospectively reviewed 183 patients who underwent graft replacement of ascending aorta and aortic arch between January 2010 and December 2020. The exclusion criteria included patients with traumatic aortic injuries (n=2), previous aortic repair within 6 months (n=2), ruptured aortic aneurysms (n=14), or a lack of preoperative laboratory data or medical records (n=10). The remaining 87% eligible patients were divided into two groups based on their preoperative serum albumin levels. The lower albumin group was defined as having serum albumin levels ≤3.5 g/dL, while the higher albumin group was defined as having albumin levels >3.5 g/dL. The incidence of mortality was compared between the two groups, and a logistic regression analysis was performed to evaluate the predictors of mortality. Results: The incidence of 1-year mortality was higher in the lower albumin group than in the higher albumin group (3.4% vs. 23.5%, p=0.006). The optimal cut-off value of albumin to predict 1-year mortality was 4.0 g/dL (area under the curve 0.885, 95% CI 0.821-0.949, p<0.001), with a sensitivity and specificity of 90.0% and 80.3%, respectively. Preoperative serum albumin levels (OR = 0.116, 95% CI 0.021-0.641, p=0.014) and diabetes mellitus (OR = 5.757, 95% CI 1.018-32.565, p=0.048) remained independent predictors of mortality. Conclusion: Preoperative serum albumin levels were an independent predictor of 1-year mortality after the graft replacement of ascending aorta and aortic arch. These findings underscore that the optimization of patients' nutritional status before surgery may be warranted and should be further explored in this high-risk population.

Large distal tear of aortic dissection

BACKGROUND: The traditional treatment for aortic dissections (ADs) is a proximal repair of AD, but the long-term prognosis of residual distal dissection is unsatisfactory. The distal aortic intimal tear of distal aortic segmental enlargement (DASE) is evaluated via its size, with risk assessment, and assessed its risk, which will provide clinicians with diagnosis and treatment direction. METHODS: We analyzed 419 ADs patients who underwent radiographic examination of the aorta between September 1999 and May 2014. We recorded the area of the aortic intimal tear and divided it into two groups (75 patients in DASE group and 344 patients in non-DASE group). Logistics regression analysis or natural logarithm transformation was used to explore the potential risk of remaining distal tears to DASE, while the Logistic multiple regress equations were used to find out the independent risk factors. RESULTS: The postoperative large tear was defined as short diameter ≥5.0 mm. The independent risk factors of DASE are as follows: Short diameter of postoperative tears (odds ratios [ORs], 1.10;95% confidence interval [CI], 1.02–1.19; P &lt; 0.0120); short diameter of the first tear after operation (OR, 1.12; 95% CI, 1.00–1.26; P &lt; 0.0580) and the existence of large tears (OR, 1.13; 95% CI, 1.01–1.26; P &lt; 0.0298). CONCLUSIONS: Our findings suggest that the size of the remaining tears and the existence of large tears are the key risk factors for patients with DASE. Patients with large remaining tears should be supervised regularly and treated timely.

Female sex is independently associated with reduced inpatient mortality after endovascular repair of blunt thoracic aortic injury.

Female sex has been associated with decreased mortality following blunt trauma, but whether sex influences outcomes of thoracic endovascular aortic repair (TEVAR) for traumatic blunt thoracic aortic injury (BTAI) is unknown. In this retrospective study of a prospectively maintained database, the Vascular Quality Initiative (VQI) registry was queried from 2013-2020 for patients undergoing TEVAR for BTAI. Univariate Student's t-tests and chi-squared tests were performed, followed by multivariate logistic regression for variables associated with inpatient mortality. 211 (26.2%) of 806 patients were female. Female patients were older (47.9 vs. 41.8 years, p<0.0001) and less likely to smoke (38.3% vs. 48.2%, p=0.044). Most patients presented with grade III BTAI (54.5% female, 53.6% male,), followed by grade IV (19.0% female, 19.5% male). Mean Injury Severity Scores (30.9 + 20.3 female, 30.5 + 18.8 male) and regional Abbreviated Injury Score did not vary by sex. Postoperatively, female patients were less likely to die as inpatients (3.8% vs 7.9% , p=0.042) and to be discharged home (41.4% vs. 52.2%, p=0.008). On multivariate logistic regression, female sex (OR 0.05, p=0.002) was associated with reduced inpatient mortality. Advanced age (OR 1.06, p< 0.001), postoperative transfusion (OR 1.05, p=0.043), increased Injury Severity Score (OR 1.03, p=0.039), postoperative stroke (OR 9.09, p= 0.016), postoperative myocardial infarction (OR 9.9, p=0.017), and left subclavian coverage (OR 2.7, p= 0.029) were associated with inpatient death. Female sex is associated with lower odds of inpatient mortality following TEVAR for BTAI, independent of age, injury severity, BTAI grade, and postoperative complications. Further study of the influence of sex on post-discharge outcomes is needed.

Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects.

Traumatic thoracic aortic injuries (TTAI) are associated with high rates of morbidity and mortality. They are classified according to the extent of damage and computed tomography angiography has the highest sensitivity and specificity for identifying the degree of injury and potential associated lesions. Treatment strategies for TTAI are based on the type and extent of injury and associated lesions. The patient's degree of stability can also help to define the choice of treatment, which can be conventional or endovascular surgery (EVAR) or even conservative management in selected cases. Among patients with adequate vascular anatomy, endovascular surgery is associated with better survival and fewer risks. The objective of this article is to describe a series of four cases followed up at a tertiary service in a Brazilian state that has few centers that provide high complexity care. Endovascular therapy was employed as the preferred method. All four patients had favorable outcomes, with no complications up to discharge, and are currently in outpatient follow-up.

Blunt traumatic aortic injury in the elderly population

Blunt thoracic aortic injury (BTAI) is a major cause of morbidity and mortality in trauma patients. Although outcomes for BTAI have been described in younger patient populations, elderly patients may present with different patterns of injury and have unique factors contributing to morbidity and mortality. This study aims to describe patterns of presentation and management in elderly patients presenting with BTAI using a nationwide database. Patients aged 65years and older with BTAI from 2007 through 2016 were identified from the American College of Surgeons Trauma Quality Improvement Program database. Baseline demographics, initial physiologic variables, and clinical outcomes were extracted from the database. Our primary outcome was in-hospital mortality. An adjusted Poisson generalized regression model was used to compare rates of mortality for thoracic endovascular aortic repair (TEVAR), open repair, and nonoperative management. During the study period, 1322 patients aged 65years and over sustained BTAI and survived past triage. Mean age was 74.7years, and 60% were male. There were low incidence rates of concomitant major head (9.4%), spine (3.1%), and abdominal (5.7%) injuries. Three hundred fifty (26.5%) underwent TEVAR, 58 (4.4%) open repair, and 914 (69.1%) were managed nonoperatively. Utilization of TEVAR increased from 13.1% to 32.7% from 2007 to 2015, with subsequent decline to 19.9% in 2016 in favor of nonoperative management. Age, gender, and mean Injury Severity Scores (ISS) did not significantly differ by management. In-hospital mortality for the entire cohort was 37.9%. In an adjusted Poisson generalized regression model using inverse probability of treatment weighting controlling for age, race, gender, ISS, and hypotension, TEVAR was associated with the lowest mortality rate (1.31 deaths/100 person-years; 95% confidence interval [CI], 1.17-1.46) compared with open repair (2.53; 95% CI, 2.32-2.75; P< .001) and nonoperative management (3.91; 95% CI, 3.60-4.25; P< .001). There was a higher incidence of acute kidney injury, acute respiratory distress syndrome, and surgical site infection in the TEVAR group. This study describes the management of and outcomes for BTAI in the elderly population. The majority of patients did not undergo operative repair, which was associated with a higher risk of in-hospital mortality. In an adjusted analysis, TEVAR was associated with the lowest mortality rate, compared with open repair and nonoperative management.

Slow Intravenous Infusion of a Novel Damage Control Cocktail Decreases Blood Loss in a Pig Polytrauma Model.

Our objective was to optimize a novel damage control resuscitation (DCR) cocktail composed of hydroxyethyl starch, vasopressin, and fibrinogen concentrate for the polytraumatized casualty. We hypothesized that slow intravenous infusion of the DCR cocktail in a pig polytrauma model would decrease internal hemorrhage and improve survival compared with bolus administration. We induced polytrauma, including traumatic brain injury (TBI), femoral fracture, hemorrhagic shock, and free bleeding from aortic tear injury, in 18 farm pigs. The DCR cocktail consisted of 6% hydroxyethyl starch in Ringer's lactate solution (14mL/kg), vasopressin (0.8U/kg), and fibrinogen concentrate (100mg/kg) in a total fluid volume of 20mL/kg that was either divided in half and given as two boluses separated by 30 minutes as control or given as a continuous slow infusion over 60 minutes. Nine animals were studied per group and monitored for up to 3 hours. Outcomes included internal blood loss, survival, hemodynamics, lactate concentration, and organ blood flow obtained by colored microsphere injection. Mean internal blood loss was significantly decreased by 11.1mL/kg with infusion compared with the bolus group (p = .038). Survival to 3 hours was 80% with infusion and 40% with bolus, which was not statistically different (Kaplan Meier log-rank test, p = .17). Overall blood pressure was increased (p < .001), and blood lactate concentration was decreased (p < .001) with infusion compared with bolus. There were no differences in organ blood flow (p > .09). Controlled infusion of a novel DCR cocktail decreased hemorrhage and improved resuscitation in this polytrauma model compared with bolus. The rate of infusion of intravenous fluids should be considered as an important aspect of DCR.

Traumatic blunt thoracic aortic injury: a 10-year single-center retrospective analysis

BackgroundApproximately 80% of patients with blunt thoracic aortic injury (BTAI) die before reaching the hospital. Most people who survive the initial injury eventually die without appropriate treatment. This study analyzed and reported the treatment strategy of a single center for BTAI in the last 10 years and the early and middle clinical results.MethodsThis retrospective study included patients diagnosed with BTAI at Xijing Hospital from 2013 to 2022. All inpatients with BTAI aged ≥ 18 years were included in this study. The clinical data, imaging findings, and follow-up results were retrospectively collected and analyzed. The Kaplan–Meier curve and multivariate logistic regression were used to compare survivors and nonsurvivors.ResultsA total of 72 patients (57% men) were diagnosed with BTAI, with a mean age of 54.2 ± 9.1 years. The injury severity score was 24.3 ± 18, with Grade I BTAI1 (1.4%), Grade II 17 (23.6%), Grade III 52 (72.2%), and Grade IV 2 (2.8%) aortic injuries. Traffic accidents were the main cause of BTAI in 32 patients (44.4%). Most patients had trauma, 37 had rib fractures (51.4%), Sixty patients (83.3%) underwent thoracic endovascular aortic repair (TEVAR) surgery, eight (11.1%) underwent conservative treatment, and only four (5.6%) underwent open surgery. The overall hospitalization mortality was 12.5%. In multivariate logistic regression, elevated creatinine levels (P = 0.041) and high Glasgow coma scale (GCS) score (P = 0.004) were the predictors of hospital mortality. The median follow-up period was 57 (28–87) months. During the follow-up period, all-cause mortality was 5.6% and no aortic-related deaths were reported. Three patients (4.2%) needed secondary surgery and two of them underwent endovascular repair.ConclusionAlthough TEVAR surgery may be associated with intra- or postoperative dissection rupture or serious complications in the treatment of Grade III BTAI, the incidence rate was only 8.9%. Nevertheless, TEVAR surgery remains a safe and feasible approach for the treatment of Grade II or III BTAI, and surgical treatment should be considered first,. A high GCS score and elevated creatinine levels in the emergency department were closely associated with hospital mortality. Younger patients need long-term follow-up after TEVAR.

Limited Aortic Intimal Tears: CT Imaging Features and Clinical Characteristics.

Limited aortic intimal tear is an uncommon lesion of the dissection spectrum. The lesion has several imaging features that are not well known, including asymmetric aortic contour abnormalities, filling defects, and various morphologic patterns, such as linear, L-shaped, T-shaped, and stellate configurations. Hemorrhage of the aortic wall may also be present in patients with this rare entity. This imaging essay reviews the CT imaging findings and clinical characteristics of patients with limited intimal tears. Keywords: Aorta, CT © RSNA, 2022.

Minimal Aortic Injury Detected on Computed Tomography Angiography during Initial Trauma Imaging: Single Academic Level 1 Trauma Center Experience.

Minimal aortic injury (MAI), a subtype of acute traumatic aortic injury, is being increasingly recognized with better imaging techniques. Given conservative management, the role of follow-up imaging albeit important yet has to be defined. All trauma chest computed tomography angiographies (CTAs) at our center between January 2012 and January 2019 were retrospectively reviewed for presence of MAI. MAIs were generally reimaged at 24 to 72 hours and then at a 7- and 30-day interval. Follow-up CTAs were reviewed for stability, progression, or resolution of MAI, along with assessment of injury severity scores (ISS) and concomitant injuries, respectively. A total of 17,569 chest CTAs were performed over this period. Incidence of MAI on the initial chest CTA was 113 (0.65%), with 105 patients receiving follow-up CTAs. The first, second, third, and fourth follow-up CTAs were performed at a median of 2, 10, 28, and 261 days, respectively. Forty five (42.9%), 22 (21%), 5 (4.8%), and 1 (1%) of the MAIs were resolved by first, second, third, and fourth follow-up CTAs. Altogether, 21 patients showed stability (mean ISS of 16.6), and 11 demonstrated improvement (mean ISS 25.8) of MAIs. Eight patients had no follow-up CTA (mean ISS 21). No progression to higher-grade injury was observed. Advancing age decreased the odds of MAI resolution on follow-up. A possible trend (p-value 0.22) between increasing ISS and time to resolution of MAIs was noted. In our series of acute traumatic MAIs diagnosed on CTA imaging, there was no progression of injuries with conservative management, questioning the necessity of sequential follow-up imaging.

Endovascular therapy in blunt traumatic aortic injuries

Aim: Blunt traumatic thoracic aortic injury (BTTAI) is a catastrophic life-threatening surgical emergency and the second most common cause of death in trauma patients. We retrospectively revealed our results for endovascularly treated BTTAI with early and long-term results. Material and Methods: During January 2009 and January 2022, patients from the emergency department with diagnosed BTTAI were retrospectively revealed. 38 patients all male except two, experienced BTTAI. 5 patients had grade IV, and 21 patients had grade III aortic injuries. Results: Mean age of the patients was 41.7±12.5 years. Technical success was 100%. Early mortality was 7.9%. The mean follow-up period was 49.7±18.3 months. In the follow-up period, there were no TEVAR-related complications. Conclusion: TEVAR is the most suitable treatment for BTTAI in the modern era. Left subclavian artery (LSA) intentional coverage may be performed however surgeon modified fenestrated stent graft (SMFSG) is an effective, economic, fast, and readily available technique for LSA revascularization without additional time.

An Unusual Presentation of a Completely Transected Aorta Presenting As Acute Limb Ischemia With Intramural Thrombus

Contrast-enhanced multidetector computed tomography is currently the preferred imaging modality to diagnose acute traumatic aortic injury (ATAI). Rarely, ATAI can present with atypical findings that make the diagnosis and further management exceptionally challenging. Furthermore, ATAI can also be associated with inferior vena cava injury showing only indirect signs on later imaging. We present an unusual case of traumatic aortic disruption mimicking acute limb ischemia.

Blunt traumatic aortic injury to the brachiocephalic and left carotid arteries

BackgroundBlunt traumatic aortic injury (BTAI) is a life-threatening pathology that most commonly occurs after traffic accidents or a fall from a considerable height. We report a rare case of traumatic double transection which included the brachiocephalic artery (BCA) and left carotid artery (LCA) following a motorcycle accident.Case presentationA 52-year-old man was brought to our emergency room for blunt trauma. Urgent computed tomography (CT) indicated BCA and LCA transection. Two weeks after the BTAI, CT indicated an increase in the size of the BCA pseudoaneurysm, a newly developed LCA pseudoaneurysm, and a spread of hematoma. An emergency partial aortic arch replacement including BCA and LCA reconstruction was performed 17 days after the BTAI. The postoperative course was good, and he was discharged 12 days later.ConclusionsAn open aortic repair appeared to be more suited in the present case because the aortic injury occurred in a branched lesion of the aortic arch. It was thought that complete stent graft coverage of the transection lesion would be difficult. Although coexisting multiple system injuries complicate aortic repair, there was a rapid enlargement of the BCA and LCA pseudoaneurysms. Therefore, strict management is needed even in the case of cervical artery injury.

ALDH2 knockout protects against aortic dissection

BackgroundThe incidence and mortality of aortic dissection (AD) are increasing. In pathological studies, macrophages, T lymphocytes and dendritic cells were found in the tunica media of the aorta. Acetaldehyde dehydrogenase 2 (ALDH2) gene polymorphisms are associated with a high incidence of hypertension in Asian populations. However, there is no clear evidence of the relationship between ALDH2 and aortic dissection in Asians. The aim of this study was to investigate the incidence of aortic dissection in different ALDH2 genotypes and explore changes in the vasculature.Materials and methodsThree-week-old male mice were administered freshly prepared β-aminopropionitrile solution dissolved in drinking water (1 g/kg/d) for 28 days to induce TAD. An animal ultrasound imaging system was used to observe the formation of arterial dissection and changes in cardiac function. Subsequently, mice were euthanized by cervical dislocation. The aortas were fixed for HE staining and EVG staining to observe aortic elastic fiber tears and pseudoluma formation under a microscope.ResultsKnockout of ALDH2 mitigated β-aminopropionitrile-induced TAD formation in animal studies. Ultrasound results showed that ALDH2 knockout reduced the degree of ascending aortic widening and the incidence of aortic dissection rupture. Pathological sections of multiple aortic segments showed that the protective effect of ALDH2 knockout was observed in not only the ascending aorta but also the aortic arch and descending aorta. The expression levels of genes related to NK CD56bright cells, Th17 cells, T cells and T helper cells were decreased in ALDH2 knockout mice treated with β-aminopropionitrile for 28 days.ConclusionALDH2 knockout protects against aortic dissection by altering the inflammatory response and immune response and protecting elastic fibers.

The frozen elephant trunk procedure: indications, outcomes and future directions.

The treatment of complex multi-segment disease concomitantly affecting the aortic arch and descending thoracic aorta is technically challenging. Until the 1990s, such extensive pathology was addressed by median sternotomy for aortic arch replacement followed by a traumatic thoraco-abdominal incision for reconstruction of the descending aorta as a single- or two-stage procedure. The advent of the conventional elephant trunk procedure by Borst in 1983 simplified the second-stage of this procedure by eliminating the need for clamping of the descending thoracic aorta. However, graft-related complications and the considerable inter-stage mortality were significant limitations associated with the conventional elephant trunk procedure. The emergence of endovascular technology and availability of dedicated arch prostheses culminated in a major paradigm change with the introduction of the frozen elephant trunk (FET) concept by Kato and colleagues in the mid-1990s. This one-stage procedure permits concurrent total aortic arch replacement with antegrade delivery of a descending aortic stent-graft which itself functions as a proximal landing zone to facilitate prospective endovascular intervention to treat residual or de novo disease in the more distal aorta. The frozen elephant technique has been applied extensively in acute aortic dissection to restore true lumen patency, occlude descending aortic intimal tears and promote false lumen thrombosis, as well as for chronic degenerative arch aneurysms. The Thoraflex Hybrid and E-vita Open are the two most common commercially available hybrid FET prostheses. This review aims to discuss the development, indications, surgical technique, currently available prostheses, clinical outcomes and future directions regarding the FET procedure.

Thoracic endovascular repair for blunt traumatic thoracic aortic injury: Long-term results.

This study aims to evaluate the endoprosthesis complications in patients undergoing TEVAR for blunt traumatic thoracic aortic injury, through long-term clinical and diagnostic follow-up. During the study interval (November 2000-October 2020), a total of 38 patients (63% male; average age 37.5years) with thoracic aortic injury underwent thoracic endovascular aortic repair. Patients underwent routine follow-up with clinical examination and radiological evaluation (CT-angiography or MRI-angiography plus chest radiograph), scheduled at 1month, at 6months (only in the cases of thoracic aortic dissection), at 1year after the procedure and every 1year thereafter. Technical success was achieved in 38 procedures (100%). The TEVAR-related mortality rate was 0%. No immediate major complications related to the endovascular procedure were observed. The median duration of diagnostic follow-up was 80months. A total of four procedure-related complications (10.5%) were identified at the follow-up. Three (7.9%) distal infoldings and collapses of the thoracic endoprosthesis and one (2.6%) type Ia endoleak were observed. No thrombosis of the prosthesis, nor signs of aortic pseudocoarctation were identified. No further complications related to endograft (endoleaks, infections, rupture, partial or complete thrombosis) occurred. No changes in the native aorta, stenosis, or increases in the endograft's diameters were observed. A total of 20 patients (52.6%) underwent MRI-angiography examinations, while a total of 34 patients (89.5%) underwent chest radiographs at the follow-up. In all cases, CT-angiography examinations were performed at the follow-up. Procedure-related complications were observed within one year of TEVAR, limiting concerns related to the durability of the prosthesis. No morphological changes in the aorta were observed despite long-term follow-up. The consequences of lifelong surveillance in terms of radiation exposure deserve special consideration, especially in younger patients treated for TAI.

A Case of Blunt Traumatic Aortic Injury with a Pseudoaneurysm in the Aortic Arch between the Brachiocephalic and Left Common Carotid Arteries

A Case of Blunt Traumatic Aortic Injury with a Pseudoaneurysm in the Aortic Arch between the Brachiocephalic and Left Common Carotid Arteries

Does altitude increase the risk of traumatic aortic injuries? A retrospective cohort study among six level I trauma centers in the United States

BackgroundTraumatic aortic injuries (TAIs) are rare but are associated with a high mortality. Prior studies have shown skiers and pilots, whose injuries occur at high altitudes, are at an increased risk for a TAI. The purpose of this study was to examine the effect of altitude on the incidence of TAIs across all causes of injury.MethodsThis retrospective cohort study at six Level I trauma centers (8/1/2016–1/1/2020) included adult blunt trauma patients with a chest or abdomen injury. High altitude injuries (> 5000 ft.) were compared to low altitude injuries (≤ 5000 ft.). The primary outcome was incidence of TAI.ResultsThere were 8562 patients, 37% were at high altitude and 63% at low altitude. High altitude patients were older (p < 0.01), more often Caucasian (p < 0.01) and had a higher ISS (p < 0.01). There was a significantly greater incidence of TAI at high altitude than low altitude (1.5% vs. 1.1%, p = 0.01). The median altitude was significantly higher for patients with a TAI than for patients without a TAI (5100 ft. vs. 1400 ft., p = 0.01). After adjustment, high altitude patients had 2-fold [OR: 2.4 (1.6, 3.7)] greater odds of having a TAI than low altitude patients.ConclusionTAIs were more prevalent among high altitude injuries. Providers should be aware of the increased incidence of TAIs at high altitudes particularly when there is a delay in diagnosis and transfer to a trauma center with appropriate resources to manage these critical injuries. TAI screening at high altitude trauma centers may improve survival rates.

Visualization of acute aortic injury with cinematic rendering.

The purpose of this study is to demonstrate the appearance of traumatic aortic injuries with the novel 3-dimensional (3D) computed tomography (CT) visualization technique known as cinematic rendering (CR). CR uses a novel lighting model to create photorealistic images with excellent anatomic detail for improved depiction of the extent of traumatic aortic injuries. Four patients with acute traumatic aortic injury identified on thoracic CT angiography were analyzed by creating standard 3D volume-rendered reconstructions and CR images on an independent 3D workstation. In this series of four patients, we present the typical patterns of aortic injury imaging findings and complications associated with traumatic aortic injury, with an emphasis on the utilization of the novel 3D technique of CR. CR can provide realistic imaging of the thoracic aortic contour with excellent spatial details. This methodology allows for an accurate assessment of aortic injury and optimal preoperative planning in patients with traumatic thoracic aortic injury.

Clinical characteristics and diagnosis and treatment strategies of patients with severe traumatic aortic injury

Objective: To investigate the clinical characteristics and diagnosis and treatment strategies of patients with severe traumatic aortic injury (TAI). Methods: A total of 25 patients with TAI, who hospitalized in our hospital between August 2005 to March 2021 and underwent thoracic aortic endovascular repair (TEVAR), were included in this retrospective study. According to the time from admission to TEVAR, the patients were divided into emergency TEVAR group (14 cases, TEVAR within 24 h of admission) and elective TEVAR group (11 cases, patients underwent surgery or fracture reduction and fixation first for serious injuries and then underwent TEVAR more than 24 h after admission). The general clinical data of patients, injury severity score (ISS), time from admission to intervention, total hospital stay, the proportion of closed chest drainage and the proportion of abdominal organ repair were obtained and compared. Clinical follow-up and 1-year postoperative aortic computed tomography angiography (CTA) were performed on the patients. Death, the occurrence of aortic adverse events and injury recovery were followed up and recorded. Results: The mean age of these 25 TAI patients was (41.4±14.4) years, 20 patients were males (80.0%). 21 patients (84.0%) had persistent chest and back pain, 17 (68.0%) had pleural effusion and 5 (20.0%) had mediastinal hematoma. The injury severity score (ISS) was significantly higher in the elective TEVAR group than in the emergency TEVAR group (24.9±14.4 vs. 35.5±9.3, P=0.044). The time from admission to intervention ((1.0±0.0) d vs. (3.4±0.9) d, P<0.001], the time from admission to TEVAR ((1.0±0.0) d vs. (11.5±13.8) d, P=0.030) and total hospital stay ((6.1±2.3) d vs. (26.8±7.7) d, P<0.001) were significantly longer in elective TEVAR group than in emergency TEVAR group. The proportion of thoracic closed drainage was significantly lower in the elective TEVAR group than in the emergency TEVAR group (9 (64.3%) vs. 2 (18.2%), P=0.042). The proportion of abdominal organ repair was significantly higher than in the emergency TEVAR group (0 vs. 4 (36.4%), P=0.026). All of 25 patients were discharged alive and followed up for (84.0±30.5) months. All patients survived and completed 1-year postoperation CTA. There were no aortic adverse events occurred, and no complications after surgery, and the fractures and organ injuries healed well. Conclusions: The clinical characteristics of severe TAI are acute multi-injuries combined with persistent chest and/or back pain, pleural effusion, and mediastinal hematoma. Timely diagnosis and treatment are important factors for the outcome. The treatment strategy for multi-injuries should give priority to dealing with life-threatening injuries. TEVAR is the primary treatment strategy for severe TAI and is related to satisfactory outcomes.

The Role of Surgical and Endovascular Repair of Blunt Traumatic Aortic Injury in the Modern Era: A Single-Center Experience.

Objective:To evaluate the efficacy of chest x-ray (CXR) in blunt traumatic aortic injury (BTAI) as a primary imaging tool in trauma patients. Methods:We retrospectively reviewed our hospital records for blunt thoracic aortic injury patients who had a therapeutic intervention from January 2015 to February 2021. Patients’ characteristics, initial chest x-rays, and computed tomography (CT) scan were extracted and re-evaluated.Results: Eighteen patients matched the criteria of our research. The mean age and the injury severity score (ISS) was 29.8±11.2 and 38.4±14.4, respectively. Seven patients (38.9%) underwent thoracic endovascular aortic repair (TEVAR), and 11 (61.1%) had open surgery. The TEVAR group had significantly lower mean intensive care unit stay days (6.6±3.9 vs. 10.8±6.9 in open aortic repair (OAR), p<0.05). The percentile of patients requiring blood transfusion was significantly lower in the TEVAR group (57% vs. 100% in OAR, p<0.05). Mediastinal widening (66.7%) was the most common finding during the evaluation of initial chest x-rays. Interestingly, 22.2% of the initial x-rays were not remarkable for BTAI.Conclusion:TEVAR is an advantageous choice in the management of BTAI. However, open aortic repair is the optimal decision in certain situations. It is suggested that the Interventional management of the BTAI must be performed by experienced vascular surgeons in a medical center capable of both OAR and TEVAR.