Single Retrograde Thoracic Branch Endoprosthesis vs Traditional Endovascular Repair With Subclavian Coverage for Treatment of Blunt Thoracic Aortic Injuries

The Gore TAG thoracic branch endoprosthesis (TBE) allows zone 2 thoracic endovascular aortic repair (TEVAR) with graft placement proximal to the left subclavian artery origin while maintaining vessel patency through a retrograde side branch. We compared our early experience with the TBE device for management of zone 2 and proximal zone 3 blunt thoracic aortic injuries (BTAI) to traditional TEVAR with left subclavian artery coverage. We retrospectively identified all patients undergoing endovascular repair for BTAI. Patient characteristics, procedural details, and outcomes are reported and compared between cohorts. Between 2005-2023, 51 patients underwent TBE placement at our institution, 11 for BTAI, while 152 patients underwent TEVAR for BTAI, 47 (31%) with left subclavian artery coverage. The mean age of the TBE cohort was 63 years (±20) vs 45 years (±19) in the TEVAR cohort (Table I). In the TBE cohort, 10 patients (91%) had complete percutaneous access (femoral and left radial artery access); the remaining patient required percutaneous brachial access and a femoral artery open exposure. Comparatively, in the TEVAR cohort, 21 patients (45%) required open exposure of an access vessel (P = .29). The mean treatment length (length of aorta excluded by a covered endograft) was 15 cm (±0 cm) in the TBE cohort vs 11 cm (±2.4 cm) in the TEVAR cohort (P < .001). Technical success, defined as successful device delivery with exclusion of injury, was 100% in both groups. In the TEVAR cohort, eight patients (17%) underwent left subclavian artery revascularization, three (38%) for extremity ischemia and one (12.5%) for ipsilateral vertebral territory stroke. The remaining patients (n = 4; 50%) underwent revascularization at the discretion of the operating surgeon. When looking at operative complications as a combined endpoint, there were no postoperative complications observed in the TBE cohort, while 11 patients in the TEVAR cohort experienced a complication, including wound infection, extremity ischemia, stroke, endoleak, or retrograde dissection (0% vs 23%; P = .64) (Table II). There were no aortic-related mortalities observed in either cohort. Side branch patency and BTAI exclusion was observed on follow up imaging at a mean of 18.5 days (range, 2-69 days) in all patients in the TBE cohort. Similarly, exclusion of the BTAI was observed in all TEVAR patients at follow-up. Use of the Gore TBE device offers a safe alternative to traditional TEVAR with subclavian coverage in the management of BTAI requiring zone 2 coverage. A larger cohort is needed to confirm these initial findings.Table IPatient demographics and aortic pathologyDemographicsTBE cohortN (%)TEVAR cohortN (%)P valueAge, years (mean ± SD)63±2045±19.007Male gender5 (45)32 (68).48Hypertension4 (36)9 (19).24History of tobacco use2 (18)14 (30).71COPD0 (0)1 (2).84Coronary artery disease1 (9)2 (4).47History of stroke0 (0)0 (0)Aortic pathology BTAI injury grade (SVS).6410 (0)1 (2)21 (9)1 (2)39 (82)39 (83)41 (9)6 (13) Zone of injury124 (36)17 (36)37 (64)30 (64) Open table in a new tab Table IIObserved complications in TEVAR cohortComplicationNo. (%)Wound infection2 (4)Endoleak3 (6)Retrograde dissection1 (3)Stroke2 (4)Left upper extremity ischemia3 (6) Open table in a new tab