Outcomes Following Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury Stratified by Society for Vascular Surgery Grade

J Vasc Surg, 2023 · DOI: 10.1016/j.jvs.2023.03.021 · Published: July 1, 2023

Simple Explanation

This study looks at outcomes for patients who had TEVAR, a procedure to repair a damaged aorta in the chest, after a blunt trauma. The severity of the aortic injury was graded using a system from the Society of Vascular Surgery (SVS). The study checked if the grade of injury affected how well patients did after TEVAR. The study found that while patients with the most severe injuries initially had worse outcomes, this difference disappeared after accounting for other health factors. Also, a small percentage of patients with the least severe injuries still underwent TEVAR and experienced complications.

Study Duration

2013-2022

Participants

1,311 patients undergoing TEVAR for BTAI

Evidence Level

Retrospective cohort study

Key Findings

1
Following TEVAR for BTAI, grade 4 aortic injury patients experienced the highest rates of perioperative mortality, aortic-related mortality, and 5-year mortality.
2
After risk-adjustment, there was no association between SVS aortic injury grade and perioperative and 5-year mortality.
3
Grade 1 aortic injury patients had a high rate of postoperative spinal cord ischemia.

Research Summary

Following TEVAR for BTAI, SVS aortic injury grade was not associated with perioperative and 5-year mortality. Over 5% of patients undergoing TEVAR belonged to grade 1, and these patients had high rates of spinal cord ischemia. Therefore, future efforts should emphasis the use of nonoperative management in these patients.

Practical Implications

Careful Patient Selection

Enables careful selection of BTAI patients who will experience more benefit than harm from operative repair.

Prevent Inadvertent TEVAR Use

Prevents the inadvertent use of TEVAR in low grade injuries.

Emphasis on Nonoperative Management

Emphasizes the value of nonoperative management of low-grade injuries.

Study Limitations

1
Retrospective design
2
Selection bias due to VQI including only patients undergoing TEVAR
3
Lack of data on outcomes for nonoperatively managed patients

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