Predictors of Surveillance Imaging Non-compliance Among Patients with TEVAR for Blunt Thoracic Aortic Injury

Objectives Blunt Thoracic Aortic Injury (BTAI) is the second leading cause of death for patients with blunt trauma. Thoracic endovascular aortic repair (TEVAR) has become the standard of care for high-grade BTAI, reducing morbidity and mortality while requiring long-term surveillance imaging to ensure graft integrity and prevent future complications. However, adherence to this protocol is poor. Previous studies evaluating the factors associated with post-operative imaging non-compliance have yielded conflicting results. This study aimed to evaluate predictors of post-TEVAR non-compliance inpatients presenting with BTAI. Methods A retrospective study on 23 patients was conducted using a single institution Aortic Center Database (2015-2025). Inclusion criteria included patients who were age >18 years and underwent TEVAR for BTAI. Demographic, comorbidity, hospital course, and follow-up data were collected. The Distressed Communities Index (DCI) score was derived from patient’s home address ZIP code. Time-to-event analysis defined loss to follow up (LTFU) for vascular imaging as the failure event. Patients were censored at death or if compliant through 1 year following the index TEVAR. Statistical analysis included chi-square, t-tests, and Kaplan-Meier survival. Results Based on this single-center review on TEVAR follow-up for BTAI, sex, race, and hospital length of stay did not impact compliance. Medical comorbidities were also non-significant. Patients who presented with a lower injury severity score ( P = 0.02) and lived more than 20 miles from their follow-up appointment ( P = 0.02) were more likely to be LTFU. While the type of facility was not impactful, all patients who were discharged to a non-home location were LTFU. Interestingly, DCI and insurance status had no impact on follow-up non-compliance. Conclusions This study supports the development of targeted, patient-centered surveillance strategies, especially amongst rural populations and those discharged to a non-home location. To fully understand this complex problem, further investigation using a larger database may be indicated.