The endovascular aortic repair for patients with traumatic thoracic aortic blunt injury

Abstract

OBJECTIVE: Blunt thoracic aortic injury is the second most common cause of death in trauma patients. Traumatic aortic injury is an emergency that patients will face death soonly, even there is no enough time to transport the patient to the hospital. In our center, all patients were treated with thoracic endovascular aortic repair (TEVAR). We retrospectively analyze the therapeutic effects of TEVAR of blunt traumatic aortic injury (BTAI) to get some inspiration for the follow-up treatment and provide valuable guidance. METHODS: We retrospectively reviewed our institutional database to identify all patients treated with TEVAR for traumatic lesions of the aortic isthmus. We have identified 22 patients since 2017. Patients’ charts were analyzed for preoperative characteristics and intraoperative variables. RESULTS: Forty-six patients were included. The median age was 56 years (23–79 years). Sixteen patients were male (73%). Most of them were graded III/IV of aortic injury. All patients were undergone endovascular treatment successfully. Six of 22 patients, showing no chest pain before admission, were presented with classic type B aortic dissection. Moreover, one patient was presented with thoracoabdominal dissection. Emergency surgery (<24 h) was performed in seven patients (32%) who experienced life-threatening injury resulting in hemorrhagic shock and hematoma formation in the mediastinum. All patients were discharged smoothly with no residual symptoms. CONCLUSIONS: Endovascular treatment of traumatic aortic dissection reduces the mortality rate of these patients who cannot tolerate traditional open surgery. According to our experience, patients who presented with simple pseudoaneurysm in enhanced computed tomography were more stable. Therefore, a postponed operation could be recommended after symptomatically hypotensive management. However, emergency surgery was necessary if patients presented with obviously mediastinal hematoma, especially progressive pleural effusion, which could result in hematoma rupture and death.