Endovascular Intervention in Blunt Traumatic Aortic Injury: Experience in Ramathibodi Hospital

Abstract

Background: Blunt thoracic aortic injury (BTAI) or transection is associated with high morbidity and mortality. Current standard practice recommended endovascular repair over open surgical repair, especially in patients with suitable anatomy. Objective: The authors reviewed our center experiences with endovascular repair of BTAI. Materials and Methods: Medical records of patients with BTAI treated with endovascular repair in the past 7 years at Ramathibodi Hospital were reviewed. Baseline demographic data, Injury Severity Score (ISS) at index events, procedure details and follow-up evaluation of clinical symptoms and imaging were obtained and analyzed. Results: From September 2014 to May 2020, 10 patients (8 men, 2 women) with mean age of 44.9+22.8 years (range 13 to 90), and mean ISS of 35.7+16.1 (range 20 to 66), were diagnosed with BTAI. Nine of them underwent uneventful endovascular repair, while one patient experienced iatrogenic cardiac tamponade. All endovascular repair procedures were performed under general anesthesia, and none of the patients received heparin due to multiple co-trauma or undergoing operation for other associated injuries. Endovascular stent grafts covered left subclavian arteries in 8 of 10 patients. There was no immediate complication in term of dead, post-procedural stroke or paraplegia as well as no symptom of left arm claudication or ischemia was reported. Mean follow-up duration was 25.5+24 months (range 2 to 73), with at least one computerized tomography angiography (CTA) performed in each patient. Neither endoleak nor stent migration were documented. Conclusion: Despite the small number of patients at our center, endovascular repair of BTAI appeared to be safe and had satisfactory outcomes. However, further long-term follow-up is needed for evaluation of durability and late complications.