Long Term Outcomes of Endovascular Repair for Blunt Traumatic Aortic Injury: A Twenty Year Multicentre Follow Up Study

Victor Mill; Carl Magnus Wahlgren; Nuno Dias; Peter Gillgren; Anders Wanhainen; Johnny Steuer; Collaborative study group

doi:10.1016/j.ejvs.2024.10.048

Long Term Outcomes of Endovascular Repair for Blunt Traumatic Aortic Injury: A Twenty Year Multicentre Follow Up Study

Eur J Vasc Endovasc Surg. 2024 Nov 14:S1078-5884(24)00923-7. doi: 10.1016/j.ejvs.2024.10.048. Online ahead of print.

Authors

Victor Mill¹, Carl Magnus Wahlgren², Nuno Dias³, Peter Gillgren⁴, Anders Wanhainen⁵, Johnny Steuer⁴; Collaborative study group

Collaborators

Collaborative study group:
Andreas Howie⁶, Angelos Karelis⁷, Birgitta Sigvant⁸, Björn Kragsterman⁹, Björn Sonesson⁷, Kevin Mani¹⁰, Mattias B Andersson¹¹, Rebecka Hultgren¹², Samuel Saers¹³, Sverker Svensjö¹⁴, Thomas Wåxnäs¹⁵, Tobias Lundström¹⁶, Åsa Anveden¹⁷

Affiliations

¹ Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset; Department of Surgery, Södersjukhuset, Stockholm, Sweden. Electronic address: victor.mill@regionstockholm.se.
² Department of Molecular Medicine and Surgery, Karolinska Institutet; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
³ Vascular Centre, Department of Thoracic and Vascular Surgery, Skåne University Hospital; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
⁴ Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
⁵ Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Peri-operative and Surgical Sciences, Section of Surgery, Umeå University, Umeå, Sweden.
⁶ Department of Surgery, Gävle hospital, Gävle, Sweden.
⁷ Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
⁸ Center of Clinical Research, Region Värmland, Sweden; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
⁹ Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
¹⁰ Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
¹¹ Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sunderbyn Hospital, Sunderbyn, Sweden.
¹² Department of Molecular Medicine and Surgery, Karolinska Institutet, Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
¹³ Department of Cardiothoracic and Vascular Surgery, Linköping University, Linköping, Sweden.
¹⁴ Falun County Hospital, Falun, Sweden.
¹⁵ Department of Surgery, Växjö Hospital, Växjö, Sweden.
¹⁶ Department of Surgery, Mälarsjukhuset, Eskilstuna, Sweden.
¹⁷ Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Halland hospital, Sweden.

PMID: 39547390
DOI: 10.1016/j.ejvs.2024.10.048

Abstract

Objective: This retrospective, multicentre, observational study analysed patients who underwent endovascular repair for blunt traumatic aortic injury (BTAI) at four tertiary trauma referral centres over twenty years. It aimed to determine early and long term survival, to analyse aortic and device related complications, and to assess the re-intervention rate after endovascular repair for BTAI.

Methods: All patients treated from 1 January 2001 to 31 October 2021 were identified using local hospital registries and two national registries: the Swedish vascular registry (Swedvasc) and Swedish trauma registry (SweTrau). Patient, treatment, and follow up data were extracted from medical records and radiology data by review of congregated imaging. The report was structured according to the STROBE checklist.

Results: Ninety five patients were included: 80 were male (84%), the median age was 42 years (interquartile range [IQR] 27, 64), and median follow up time was 6.1 years (IQR 0.7, 12.4). The thirty day mortality rate was 16% (15 of 93), 40% of these were caused by traumatic brain injury and 33% by aortic related causes. Estimated overall survival was 57% (standard error 6.6) at fifteen years after index treatment. Aortic re-intervention procedures (re-stenting, coiling, or explantation) were performed in 14 of 86 patients (16%), six of whom underwent stent graft explantation. Seven of the 14 patients (50%) who underwent aortic re-intervention presented with symptoms and six of 14 had a device related complication. All complications that required aortic re-intervention were diagnosed within eighteen months of the index procedure. There was no association between injury grade and aortic re-intervention.

Conclusion: Thoracic endovascular aortic repair is an effective treatment for patients with BTAI needing intervention. It carries low rates of device related complications and death, and the long term outcomes are acceptable. As all aortic complications requiring re-intervention were identified during the first two years after index treatment, with half of the patients reporting symptoms, future follow up protocols should be adjusted accordingly.

Keywords: Aortic injury; Blunt traumatic aortic injury; TEVAR; Transection; Vascular trauma.