Outcomes of thoracic endovascular aortic repair for blunt thoracic aortic injury with emphasis on short proximal sealing zones ≤ 15 mm

Blunt thoracic aortic injury (BTAI) is the second leading cause of mortality in patients with trauma, closely following head injuries, which remain a significant concern in trauma care. Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for BTAI; however, insufficient proximal sealing zone length poses a significant challenge for successful TEVAR. This study aimed to investigate the outcomes of TEVAR in patients with BTAI, including those with short proximal sealing zones (≤ 15 mm).

This retrospective study included 52 consecutive patients who underwent TEVAR for BTAI in the authors’ institution between January 2018 and December 2023. Patient demographics, BTAI grade, adverse events, and endoleak were assessed. Proximal sealing zone length was measured on pre-procedural computed tomography (CT). Subgroup analysis was used to compare outcomes between patients with proximal sealing zones ≤ 15 and > 15 mm.

The average injury severity score was 44.1 ± 15.8, with 88.5% of patients sustaining grade 3 BTAI. One technical failure occurred owing to an acute aortic arch angle. A total of 29 patients had proximal sealing zones ≤ 15 mm, with 5 of them undergoing left subclavian artery coverage. Endoleak occurred in three patients (5.9%), resulting in the death of one patient. The remaining two patients had suspected type 4 endoleaks that resolved on follow-up CT. No significant differences were observed in aortic-related mortality and endoleak between the two groups.

TEVAR is an effective treatment option for BTAI, even in patients with short proximal sealing zones ≤ 15 mm.