Long-Term Outcomes of Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury Is Not Related to the Severity of Aortic Injury

Thoracic endovascular aortic repair (TEVAR) is now the standard of care for the management of aortic injury from trauma. Long-term outcomes stratified by the severity of the aortic injury are limited. This is a single-center, retrospective analysis of all patients who underwent TEVAR for trauma between January 2008 and November 2023. Long-term outcomes of mortality and reintervention were stratified and compared based on the blunt thoracic aortic injury score. The Kaplan-Meier analysis was used to compute 1- and 5-year survival. A total of 104 patients (aged 42 ± 15 years; 72 males; 69%) underwent TEVAR for trauma. Most repairs were for grade 3 (59 patients, 57%) or grade 4 (30 patients, 29%) blunt aortic injuries. The remaining patients included grade 1 (1 patient, 1%) and grade 2 (14 patients, 13%). Grade 4 injuries were not associated with higher rate of concomitant neurologic injuries (P = .33) or death (P = .74). Eighty-seven percent patients had a mean follow-up of 3.5 ± 3.4 years. Two patients died due to aortic-related causes within 30 days (intraoperative hemorrhage in one patient, graft collapse in one patient who had an unsuccessful exploratory thoracotomy). Overall, 1-year survival was 92%, and 5-year survival was 88% by the Kaplan-Meier analysis. Patients with neurologic injury trended toward higher mortality in the Kaplan-Meier analysis, but this was not statistically significant (Fig 1; log-rank = 0.22). The grade of injury was not significant for long-term survival (Fig 2; log-rank = 0.81). Early reintervention was required in 2% patients with none required in long term. Age >40 years (P = 0.17), female sex (P = .34), and graft diameter >26 mm (P = .41) were not significant for reintervention. None of the patients experienced endoleaks or spinal cord ischemia. TEVAR is a durable repair for patients with BTAI requiring no reintervention after 1-year follow-up. Computed tomography surveillance of TEVAR in the setting of trauma should be limited to 1 and 5 years after surgery. Long-term survival is not related to the severity of BTAI.Fig 2Kaplan-Meier survival curve demonstrating survival based on the grade of injury. Log=rank = 0.81.