Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: an 11-year single-center retrospective cohort study

The optimal timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) remains controversial. Although early repair has traditionally been advocated, delayed intervention may be safe in selected patients. We aimed to compare outcomes between early and delayed TEVAR and to identify factors associated with in-hospital mortality. This retrospective cohort study included adult patients with BTAI who underwent TEVAR at a level I trauma center in South Korea between January 2014 and December 2024. Patients managed conservatively or who died on arrival or during emergency department (ED) resuscitation were excluded. Early TEVAR was defined as repair performed within 24 h of ED arrival, whereas delayed TEVAR was defined as repair performed more than 24 h after ED arrival. The primary outcome was in-hospital mortality. Univariable and multivariable logistic regression and Kaplan–Meier survival analyses were performed. Among 76 patients, 61 (80.3%) underwent early TEVAR and 15 (19.7%) underwent delayed TEVAR. Baseline characteristics did not differ significantly between groups. In-hospital mortality occurred in 13 patients (17.1%), all in the early TEVAR group (21.3% vs. 0.0%; P = 0.060), and all deaths were due to non-aortic causes. There were no statistically significant between-group differences in hospital and intensive care unit (ICU) lengths of stay, ICU-free days, mechanical ventilation duration, ventilator-free days, or aortic- and TEVAR-related events. In multivariable analysis, fall as an injury mechanism (odds ratio [OR], 16.40; 95% confidence interval [CI], 1.46–184.83; P = 0.024) and higher Injury Severity Score (OR, 1.11; 95% CI, 1.01–1.22; P = 0.037) were independently associated with mortality. After adjustment, there was no statistically significant association between early TEVAR and mortality (OR, 8.63; 95% CI, 0.79–1255.88; P = 0.085), and survival did not differ significantly between groups (log-rank P = 0.051). In-hospital mortality and other clinical outcomes did not significantly differ between the early and delayed TEVAR groups. In the adjusted analysis, there was no statistically significant association between TEVAR timing and in-hospital mortality, although the estimate was imprecise. TEVAR timing should therefore be individualized according to physiologic status, aortic injury characteristics, and associated injury burden.