Timing of Endovascular Intervention in Blunt Thoracic Aortic Injury

Purpose: Timing of the endovascular intervention is an undetermined issue in patients with blunt thoracic aortic injury (BTAI). Priority of the endovascular intervention is generally affected by coexisting trauma-induced organ damage. In this abstract, we share our 2-year experience with aortic injuries in multitrauma patients.

Materials and Methods: This study analyzed the early and midterm results of patients with BTAI in the previous 2 years. The study involves 15 patients (13 men and 2 women) who applied to our tertiary health care service with BTAI. The data were retrospectively collected from the hospital records. According to Society for Vascular Surgery grading system of BTAI, we performed close surveillance and best medical therapy in grade I patients. We chose delayed intervention according to priority of the associated injuries in grade II and III patients. For grade IV BTAI or free rupture of the thoracic aorta, we performed emergency repair.

Results: The mean age of the patients was 48 ± 17 years. The most common cause of the trauma was motor vehicle accident (66%). The other reasons were falling from high height (6%), landslide (6%), and acceleration and deceleration injuries related to other traumas. Eleven patients were treated by thoracic endovascular aneurysm repair (TEVAR), and four patients with minor BTAI were treated with best medical therapy and close surveillance. Mean duration of stay in intensive care unit was 4 ± 3 days, and hospitalization was 9 ± 5 days. There was no in-hospital mortality. Two endoleaks occurred in two patients treated by TEVAR. Three patients’ subclavian arteries had to be closed because of inadequate proximal landing zones. Low-dose heparin was used for the patients with intracranial or other visceral organ damage in the TEVAR procedure. The oversizing of the stent graft was below 10%.

Conclusions: BTAI is a rarely encountered lethal injury. It has a 75% mortality rate and is the second most common cause of dead in trauma patients after intracranial hemorrhage. TEVAR is the optimal, less invasive, and rapid treatment modality for patients with BTAI. It has lower mortality and morbidity rates than open surgery and enables a quick hemodynamic stabilization of polytrauma patients. The timing of the intervention should be decided according to severity of the aortic injury and the other organ damages.