Long-Term Survival after TEVAR for Traumatic Aortic Ruptures

Objectives: Thoracic aortic injury due to blunt chest trauma remains one of the most fatal injuries in patients suffering from polytrauma. Thus far, there are no long-term follow-up data for larger patient collectives after TEVAR for acute traumatic aortic rupture. The purpose of this study was to illustrate a single-center long-term follow-up of a comparatively large patient collective receiving TEVAR for traumatic aortic rupture.

Methods: We retrospectively screened a single-center database of thoracic endovascular aortic repairs (TEVAR). In this study we included patients who (1) suffered from a polytrauma with an injury severity score (ISS) greater than 15, (2) received endovascular repair of the affected aortic segment, and (3) completed a 5-year follow-up period.

Result: A total of 74 patients were included in the analysis. The reason for polytrauma can be divided into either “fall from great high” (n = 15, 21%) or “traffic accident” (n = 56, 78%). 19 (26%) patients died during the first 30-days after admission. The 5-year survival group, was significantly older at the time of the incident than the 5-year nonsurvival group (52 (±21) versus 36 (±16) years, p = 0.001; for age >40 years: OR: 3.938, CI: 1.379–11.246, p = 0.008). In 58% (n = 43) of the cases, the first trauma surgery was performed before TEVAR. In this group, the 5 year mortality was significantly higher (83 vs. 71%, p = 0.03). Whether TEVAR was performed within or later than 24 hours after the incident had no significant impact on long-term mortality (6 (29%) versus 11 (24%), p = 0.72). 5-year follow-up showed significantly shorter time intervals between trauma and TEVAR (1.48 [±2.8] vs. 14.2 [±61.9] p = 0.35) as well as trauma surgery and TEVAR (2.9 (±4.6) vs. 6.3 (±18.3), p = 0.63) than survivors. The aortic rupture was mainly seen in the proximal segment of the descending aorta (89%) which was stented with a proximal landing in zone 3 (44%) or zone 2 (41%). 7 (9%) patients received a carotid-subclavian bypass either during the first procedure or subsequently due to malperfusion of the left arm. In the further course two patients needed a conventional replacement of the aortic arch and the descending aorta (1 month, 9 months after the initial trauma), and two patients needed re-TEVAR due to distal endoleaks Type 1b. Survival rates were: 75% for 30-day; 68% for 1 year-, and 54% for 5-year follow-up.

Conclusion: The reported data reveal good short-, intermediate-, and long-term survival rates for TEVAR in this complex and high-risk patient cohort.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021