Endovascular treatment of traumatic thoracic aortic injuries in patients with normal anatomy and anatomical variants: safety, efficacy and long-term follow-up

Abstract

Purpose: To evaluate the safety and the efficacy of thoracic endovascular aortic repair (TEVAR) in patients with traumatic thoracic aortic injuries (TTAIs), analyzing the mid-long-term outcomes. Materials and methods: In this retrospective and monocentric study, 20 patients (46 ± 17.0 years old; mean ± SD) underwent TEVAR for TTAI from February 2012 to April 2023. All patients were subjected to computed tomography angiography (CTA) before discharge; afterward, the follow-up was set up by CTA or magnetic resonance imaging (MRI). Technical success, clinical success, safety, and mid-long-term follow-up were evaluated. Results: Both technical and clinical success were 100%. No procedure-related death was reported. Safety was 95%. In four (20%) patients the left subclavian artery (LSA) was covered; in one out of these four (25%), revascularization was necessary through carotid-subclavian bypass. In a patient with an anatomic variant of aberrant right subclavian artery (ARSA) a stent placement was required. The follow-up’s median duration was 17 ± 79.5 months (median ± IQR) and in three cases there were minimal complications: a stable type IA endoleak (EL) < 1 cm, a minimal irregularity of device’s links, and a millimeter bird beak sign. Conclusions: TEVAR for TTAI was found to be safe (3 minimal complications) and effective both in the short and mid-long term. Patients’ adherence to follow-up and contrast-induced kidney damage remains a challenge, but the use of MRI may be a valid alternative, avoiding ionizing radiation and the use of iodinated contrast media.