Midterm follow-up results and postoperative aortic remodeling of blunt aortic injuries after endovascular treatment_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Wan ¹ , FU Weiguo ² , CHEN Bin ² , XU Xin ² , GUO Daqiao ² ,  SHI Zhenyu ² , ZHUANG Shunjiu ¹

1. Department of Vascular Surgery, Huadong Hospital, Affiliated to Fudan University, Shanghai, 200040, P.R.China;
2. Department of Vascular Surgery, Zhongshan Hospital, Affiliated to Fudan University, Shanghai, 200032, P.R.China;

Corresponding author：

SHI Zhenyu, Email: maxshizhenyu@163.com

Keywords：

Blunt; aortic injury; pseudoaneurysm; transection; endovascular

DOI：

10.7507/1007-4848.201706055

Video：

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Objective To summarize the mid-term follow-up results and postoperative aortic remodeling of treating blunt aortic injuries (BAI) with thoracic endovascular aortic repair (TEVAR).Methods A retrospective study was conducted on BAI patients treated with TEVAR, who were admitted into the Department of Vascular Surgery in Zhongshan Hospital, Affiliated to Fudan University between September 2003 and December 2015. There were 15 males and 9 females at an average age of 45.6±14.0 years. The mechanism of BAI was mainly auto car crash. Totally 25 entry tears were detected and most of them were located at the aortic isthmus.Results Twenty-four BAI patients survived and eventually went through TEVAR. One patient died of pulmonary embolism 1 week post-TEVAR. Rate of technical success, clinical success and perioperative mortality was 100.0%, 95.8%, and 4.2%, respectively. Nineteen patients were followed up with a mean time of 35.1(13-87) months. All of them survived this period. Based on the follow-up imaging of CTA, 18 of them revealed no endoleak or stent migration, and 1 patient of transection still had perfusion of distal false lumen at the abdominal aorta. None of the aortic segments measured in this study showed expansion of ≥5 mm during follow-up. The aorta remodeled well in 94.7% of them.Conclusion TEVAR for treating BAI appears feasible with high rates of technical and clinical success rates. The mid-term follow-up results seems satisfying, but the long-term results are yet to be assessed with further follow-up.

Citation： ZHANG Wan, FU Weiguo, CHEN Bin, XU Xin, GUO Daqiao, SHI Zhenyu, ZHUANG Shunjiu. Midterm follow-up results and postoperative aortic remodeling of blunt aortic injuries after endovascular treatment. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(4): 278-283. doi: 10.7507/1007-4848.201706055 Copy

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2.	Teixeira PG, Inaba K, Barmparas G, et al. Blunt thoracic aortic injuries: an autopsy study. J Trauma, 2011, 70(1): 197-202.
3.	Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg, 2011, 53(1): 187-192.
4.	Rabin J, DuBose J, Sliker CW, et al. Parameters for successful nonoperative management of traumatic aortic injury. J Thorac Cardiovasc Surg, 2014, 147(1): 143-149.
5.	Baikoussis NG, Apostolakis EE, Siminelakis SN, et al. Intramural haematoma of the thoracic aorta: who’s to be alerted the cardiologist or the cardiac surgeon? J Cardiothorac Surg, 2009, 4: 54.
6.	Xenos ES, Abedi NN, Davenport DL, et al. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg, 2008, 48(5): 1343-1351.
7.	Khoynezhad A, Azizzadeh A, Donayre CE, et al. Results of a multicenter, prospective trial of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial). J Vasc Surg, 2013, 57(4): 899-905.
8.	张婉, 史振宇, 符伟国, 等. 钝性外伤后胸主动脉扩张性病变的临床分析. 中华普通外科杂志, 2010, 25(3): 198-201.
9.	Baker SP, O’Neill B, Haddon WJr, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma, 1974, 14(3): 187-196.
10.	Demetriades D, Velmahos GC, Scalea TM, et al. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma multicenter study. J Trauma, 2008, 64(3): 561-570.
11.	Siegel JH, Belwadi A, Smith JA, et al. Analysis of the mechanism of lateral impact aortic isthmus disruption in real-life motor vehicle crashes using a computer-based finite element numeric model: with simulation of prevention strategies. J Trauma, 2010, 68(6): 1375-1395.
12.	Demetriades D. Blunt thoracic aortic injuries: crossing the Rubicon. J Am Coll Surg, 2012, 214(3): 247-259.
13.	Demetriades D, Velmahos GC, Scalea TM, et al. Blunt traumatic thoracic aortic injuries: early or delayed repair-results of an American Association for the Surgery of Trauma prospective study. J Trauma, 2009, 66(4): 967-973.
14.	Bent CL, Matson MB, Sobeh M, et al. Endovascular management of acute blunt traumatic thoracic aortic injury: A single center experience. J Vasc Surg, 2007, 46(5): 920-927.
15.	Patterson BO, Holt PJ, Nienaber C, et al. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair. J Vasc Surg, 2014, 60(6): 1491-1497.
16.	Rizvi AZ, Murad MH, Fairman RM, et al. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg, 2009, 50(5): 1159-1169.
17.	Si Y, Fu W, Liu Z, et al. Coverage of the left subclavian artery without revascularization during thoracic endovascular repair is feasible: a prospective study. Ann Vasc Surg, 2014, 28(4): 850-859.
18.	Hartley MC, Langan EM, Cull DL, et al. Evaluation of the diameter of the proximal descending thoracic aorta with age: implications for thoracic aortic stent grafting. Ann Vasc Surg, 2009, 23(5): 639-644.
19.	Forbes TL, Harris JR, Lawlor DK, et al. Aortic dilatation after endovascular repair of blunt traumatic thoracic aortic injuries. J Vasc Surg, 2010, 52(1): 45-48.
20.	Miller LE. Potential long-term complications of endovascular stent grafting for blunt thoracic aortic injury. Sci World J, 2012, 2012: 897489.

1. Clancy TV, Gary Maxwell J, Covington DL, et al. A statewide analysis of level I and II trauma centers for patients with major injuries. J Trauma, 2001, 51(2): 346-351.
2. Teixeira PG, Inaba K, Barmparas G, et al. Blunt thoracic aortic injuries: an autopsy study. J Trauma, 2011, 70(1): 197-202.
3. Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg, 2011, 53(1): 187-192.
4. Rabin J, DuBose J, Sliker CW, et al. Parameters for successful nonoperative management of traumatic aortic injury. J Thorac Cardiovasc Surg, 2014, 147(1): 143-149.
5. Baikoussis NG, Apostolakis EE, Siminelakis SN, et al. Intramural haematoma of the thoracic aorta: who’s to be alerted the cardiologist or the cardiac surgeon? J Cardiothorac Surg, 2009, 4: 54.
6. Xenos ES, Abedi NN, Davenport DL, et al. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg, 2008, 48(5): 1343-1351.
7. Khoynezhad A, Azizzadeh A, Donayre CE, et al. Results of a multicenter, prospective trial of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial). J Vasc Surg, 2013, 57(4): 899-905.
8. 张婉, 史振宇, 符伟国, 等. 钝性外伤后胸主动脉扩张性病变的临床分析. 中华普通外科杂志, 2010, 25(3): 198-201.
9. Baker SP, O’Neill B, Haddon WJr, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma, 1974, 14(3): 187-196.
10. Demetriades D, Velmahos GC, Scalea TM, et al. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma multicenter study. J Trauma, 2008, 64(3): 561-570.
11. Siegel JH, Belwadi A, Smith JA, et al. Analysis of the mechanism of lateral impact aortic isthmus disruption in real-life motor vehicle crashes using a computer-based finite element numeric model: with simulation of prevention strategies. J Trauma, 2010, 68(6): 1375-1395.
12. Demetriades D. Blunt thoracic aortic injuries: crossing the Rubicon. J Am Coll Surg, 2012, 214(3): 247-259.
13. Demetriades D, Velmahos GC, Scalea TM, et al. Blunt traumatic thoracic aortic injuries: early or delayed repair-results of an American Association for the Surgery of Trauma prospective study. J Trauma, 2009, 66(4): 967-973.
14. Bent CL, Matson MB, Sobeh M, et al. Endovascular management of acute blunt traumatic thoracic aortic injury: A single center experience. J Vasc Surg, 2007, 46(5): 920-927.
15. Patterson BO, Holt PJ, Nienaber C, et al. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair. J Vasc Surg, 2014, 60(6): 1491-1497.
16. Rizvi AZ, Murad MH, Fairman RM, et al. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg, 2009, 50(5): 1159-1169.
17. Si Y, Fu W, Liu Z, et al. Coverage of the left subclavian artery without revascularization during thoracic endovascular repair is feasible: a prospective study. Ann Vasc Surg, 2014, 28(4): 850-859.
18. Hartley MC, Langan EM, Cull DL, et al. Evaluation of the diameter of the proximal descending thoracic aorta with age: implications for thoracic aortic stent grafting. Ann Vasc Surg, 2009, 23(5): 639-644.
19. Forbes TL, Harris JR, Lawlor DK, et al. Aortic dilatation after endovascular repair of blunt traumatic thoracic aortic injuries. J Vasc Surg, 2010, 52(1): 45-48.
20. Miller LE. Potential long-term complications of endovascular stent grafting for blunt thoracic aortic injury. Sci World J, 2012, 2012: 897489.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Midterm follow-up results and postoperative aortic remodeling of blunt aortic injuries after endovascular treatment

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