Clinical Analysis of TEVAR in Blunt Thoracic Aortic Injury

Ku, Gwan Woo; Choi, Jin Ho; Choi, Min Suk; Park, Sang Soon; Sul, Young Hoon; Go, Seung Je; Ye, Jin Bong; Kim, Joong Suck; Kim, Yeong Cheol; Hwang, Jung Joo

Abstract

PURPOSE
Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury.
METHODS
Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014.
RESULTS
Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was 105.64+/-24.60 mm Hg, and the mean heart rate was 103.64+/-20.02 per minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was 21.82+/-16.37 hours. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur.
CONCLUSION
Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.