Blunt Traumatic Aortic Injury: 10-Year Single-Center Experience

Abstract

Objective In blunt trauma patients, injury of the thoracic aorta is the second most common cause of death after head injury. In recent years, thoracic endovascular aortic repair (TEVAR) has largely replaced open repair as the primary treatment modality, and delayed repair of stable aortic injuries has been shown to improve mortality. In light of these major advancements, we present a 10-year institutional experience from a tertiary cardiovascular surgery center. Methods Records of patients who underwent endovascular or open repair of the ascending, arch or descending thoracic aorta between January 2009 and December 2018 were retrospectively analyzed. Patients without blunt traumatic etiology were excluded. Perioperative data were retrospectively collected from patient charts. Long-term follow-up was performed via data from follow-up visits and phone calls. Results A total of 1,667 patients underwent 1,740 thoracic aortic procedures (172 TEVAR and 1,568 open repair). There were 13 patients (12 males) with a diagnosis of blunt thoracic aortic injury. Mean patient age was 43.6 years (range, 16–80 years). Ten (77%) patients underwent TEVAR, two (15.4%) underwent open repair, and one (7.7%) was treated nonoperatively. Procedure-related stroke was observed in one (7.7%) case. Procedure-related paraplegia did not occur in any patients. Left subclavian artery origin was covered in seven patients. None developed arm ischemia. Hospital survivors were followed-up for an average of 60.2 months (range, 4–115 months) without any late mortality, endoleak, stent migration, arm ischemia, or reintervention. Conclusion Blunt thoracic aortic injury is a rare but highly fatal condition. TEVAR offers good early and midterm results. Left subclavian artery coverage can be performed without major complications.

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

“…In-hospital and midterm outcomes after open and endovascular repair for BTAI are good for patients who survive to hospital discharge. 2-4 However, long-term data are limited that report outcomes after open or endovascular surgical repair for blunt aortic injury. The SVS clinical practice guidelines for traumatic thoracic aortic injury suggest that follow-up after TEVAR could be decreased to every 2 to 5 years in the absence of abnormalities on follow-up imaging (ie, stent graft migration, endoleak) or could follow-up standard postoperative imaging surveillance paradigms.…”

“…In-hospital data suggest that endograft malposition (3%) and endoleak (2%) may occur in some patients immediately after endovascular repair, 1 but midterm data after open or endovascular repair of BTAIs suggest a low incidence of endoleak, stent migration, or reintervention after a mean of 52 to 60 months. 2-4 Long-term data for outcomes of open or endovascular repair of BTAI are lacking.…”

Diagnostic Approaches to Vascular Injury in Polytrauma—A Literature Review

“…Loss of aortic knob contour is the most reliable sign to indicate blunt aortic injury. Mediastinum widening accompanied by tracheal deviation to the left may be indicative of an innominate artery injury [ 12 , 13 , 14 , 15 ] (See Figure 1 ). The AP projection may overestimate these features, and normal chest X-ray does not rule out traumatic vascular injury [ 14 ].…”

Biomechanical study on the effect of atherosclerosis on the vulnerability of thoracic aorta, and it’s role in the development of traumatic aorta injury

“…Traumatic aorta injury (TAI) is the second most common traumatic cause of death preceded only by head injuries, being responsible for 5% to 30% of all mortalities in high-speed deceleration injuries [2][3][4]. Apart from traffic accidents, falling from height is also a common cause of TAI [5], the incidence of TAI in fatal cases of falling from height is 6% -15% [6,7].…”