Influence of Thoracic Endovascular Repair on Aortic Morphology in Patients Treated for Blunt Traumatic Aortic Injuries: Long Term Outcomes in a Multicentre Study

BTAI Study Group

Research output: Contribution to journalArticle

Abstract

Objective: The aim of this study was to evaluate aortic remodelling and associated complications in patients treated by thoracic endovascular aneurysm repair (TEVAR) for blunt traumatic aortic injuries (BTAI). Methods: This was a retrospective, observational, multicentre study. Remodelling was considered as aortic diameter variations of >2 mm and distal graft and aortic axis angle modification measured by computed tomography angiography (CTA). The predefined levels of measurement were the proximal end of the graft (D1: landing in zone [LZ] 2; D2: LZ 3); distal end (D3); and control measurement (D4) 15 mm beyond D3. Survival, procedure, graft, and/or radiation exposure related complications were registered. CTA was required within three months and at one, six, and 10 years post-operatively. Results: Between 2004 and 2017 52 patients were treated; 47 were included for remodelling analysis (five immediate deaths were excluded); median age was 47 years (range 20–80 years). Mean TEVAR oversizing was 19.6% ± 9.7% (range 5%–35%). Following a median follow up of 67.4 ± 56.1 months (range 14–153 months) survival at one, three, six, and 10 years was 90.4% (standard error [SE] 4.1%), 88.3% (SE 4.5%) 84.8% (SE 5.5%), and 84.8% (SE 5.5%), respectively. There were no procedure/graft related complications except for one late intramural haematoma that required re-intervention. Freedom from aortic remodelling at one, six, and 10 years was 85.1% (SE 5.2%), 30.9% (SE 8.6%), and 24.7% (SE 8.8%), respectively. The increase in D1/D2 and D3 diameters were influenced by time from intervention (both p <.001), age (p <.001 and p =.002, respectively) and sealing in zone 2 (p =.027 and p =.042, respectively). For every 10% increase in oversizing, proximal neck diameter remodelling was 3.4% (p =.05). The distal axis decreased over time (p <.001; significant between three and six years). Conclusion: TEVAR is safe for BTAI in the mid to long term. This study reports a correlation between time, oversizing, and remodelling, but the level of adverse events was low.

Original languageEnglish
JournalEuropean Journal of Vascular and Endovascular Surgery
DOIs
Publication statusAccepted/In press - Jan 1 2020
Externally publishedYes

Fingerprint

Multicenter Studies
Aneurysm
Thorax
Transplants
Wounds and Injuries
Graft Survival
Hematoma
Observational Studies
Survival
Computed Tomography Angiography
Radiation Exposure

Keywords

  • Blunt injury
  • Endovascular technique
  • Thoracic aorta

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{e67416d4e4ee4a188b962d22a8377616,
title = "Influence of Thoracic Endovascular Repair on Aortic Morphology in Patients Treated for Blunt Traumatic Aortic Injuries: Long Term Outcomes in a Multicentre Study",
abstract = "Objective: The aim of this study was to evaluate aortic remodelling and associated complications in patients treated by thoracic endovascular aneurysm repair (TEVAR) for blunt traumatic aortic injuries (BTAI). Methods: This was a retrospective, observational, multicentre study. Remodelling was considered as aortic diameter variations of >2 mm and distal graft and aortic axis angle modification measured by computed tomography angiography (CTA). The predefined levels of measurement were the proximal end of the graft (D1: landing in zone [LZ] 2; D2: LZ 3); distal end (D3); and control measurement (D4) 15 mm beyond D3. Survival, procedure, graft, and/or radiation exposure related complications were registered. CTA was required within three months and at one, six, and 10 years post-operatively. Results: Between 2004 and 2017 52 patients were treated; 47 were included for remodelling analysis (five immediate deaths were excluded); median age was 47 years (range 20–80 years). Mean TEVAR oversizing was 19.6{\%} ± 9.7{\%} (range 5{\%}–35{\%}). Following a median follow up of 67.4 ± 56.1 months (range 14–153 months) survival at one, three, six, and 10 years was 90.4{\%} (standard error [SE] 4.1{\%}), 88.3{\%} (SE 4.5{\%}) 84.8{\%} (SE 5.5{\%}), and 84.8{\%} (SE 5.5{\%}), respectively. There were no procedure/graft related complications except for one late intramural haematoma that required re-intervention. Freedom from aortic remodelling at one, six, and 10 years was 85.1{\%} (SE 5.2{\%}), 30.9{\%} (SE 8.6{\%}), and 24.7{\%} (SE 8.8{\%}), respectively. The increase in D1/D2 and D3 diameters were influenced by time from intervention (both p <.001), age (p <.001 and p =.002, respectively) and sealing in zone 2 (p =.027 and p =.042, respectively). For every 10{\%} increase in oversizing, proximal neck diameter remodelling was 3.4{\%} (p =.05). The distal axis decreased over time (p <.001; significant between three and six years). Conclusion: TEVAR is safe for BTAI in the mid to long term. This study reports a correlation between time, oversizing, and remodelling, but the level of adverse events was low.",
keywords = "Blunt injury, Endovascular technique, Thoracic aorta",
author = "{BTAI Study Group} and Stefano Gennai and Nicola Leone and Francesco Andreoli and Elisa Munari and Raffaella Berchiolli and Luciana Arcuri and Nicola Tusini and Luigi Marcheselli and Roberto Silingardi",
year = "2020",
month = "1",
day = "1",
doi = "10.1016/j.ejvs.2019.05.008",
language = "English",
journal = "European Journal of Vascular and Endovascular Surgery",
issn = "1078-5884",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Influence of Thoracic Endovascular Repair on Aortic Morphology in Patients Treated for Blunt Traumatic Aortic Injuries

T2 - Long Term Outcomes in a Multicentre Study

AU - BTAI Study Group

AU - Gennai, Stefano

AU - Leone, Nicola

AU - Andreoli, Francesco

AU - Munari, Elisa

AU - Berchiolli, Raffaella

AU - Arcuri, Luciana

AU - Tusini, Nicola

AU - Marcheselli, Luigi

AU - Silingardi, Roberto

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objective: The aim of this study was to evaluate aortic remodelling and associated complications in patients treated by thoracic endovascular aneurysm repair (TEVAR) for blunt traumatic aortic injuries (BTAI). Methods: This was a retrospective, observational, multicentre study. Remodelling was considered as aortic diameter variations of >2 mm and distal graft and aortic axis angle modification measured by computed tomography angiography (CTA). The predefined levels of measurement were the proximal end of the graft (D1: landing in zone [LZ] 2; D2: LZ 3); distal end (D3); and control measurement (D4) 15 mm beyond D3. Survival, procedure, graft, and/or radiation exposure related complications were registered. CTA was required within three months and at one, six, and 10 years post-operatively. Results: Between 2004 and 2017 52 patients were treated; 47 were included for remodelling analysis (five immediate deaths were excluded); median age was 47 years (range 20–80 years). Mean TEVAR oversizing was 19.6% ± 9.7% (range 5%–35%). Following a median follow up of 67.4 ± 56.1 months (range 14–153 months) survival at one, three, six, and 10 years was 90.4% (standard error [SE] 4.1%), 88.3% (SE 4.5%) 84.8% (SE 5.5%), and 84.8% (SE 5.5%), respectively. There were no procedure/graft related complications except for one late intramural haematoma that required re-intervention. Freedom from aortic remodelling at one, six, and 10 years was 85.1% (SE 5.2%), 30.9% (SE 8.6%), and 24.7% (SE 8.8%), respectively. The increase in D1/D2 and D3 diameters were influenced by time from intervention (both p <.001), age (p <.001 and p =.002, respectively) and sealing in zone 2 (p =.027 and p =.042, respectively). For every 10% increase in oversizing, proximal neck diameter remodelling was 3.4% (p =.05). The distal axis decreased over time (p <.001; significant between three and six years). Conclusion: TEVAR is safe for BTAI in the mid to long term. This study reports a correlation between time, oversizing, and remodelling, but the level of adverse events was low.

AB - Objective: The aim of this study was to evaluate aortic remodelling and associated complications in patients treated by thoracic endovascular aneurysm repair (TEVAR) for blunt traumatic aortic injuries (BTAI). Methods: This was a retrospective, observational, multicentre study. Remodelling was considered as aortic diameter variations of >2 mm and distal graft and aortic axis angle modification measured by computed tomography angiography (CTA). The predefined levels of measurement were the proximal end of the graft (D1: landing in zone [LZ] 2; D2: LZ 3); distal end (D3); and control measurement (D4) 15 mm beyond D3. Survival, procedure, graft, and/or radiation exposure related complications were registered. CTA was required within three months and at one, six, and 10 years post-operatively. Results: Between 2004 and 2017 52 patients were treated; 47 were included for remodelling analysis (five immediate deaths were excluded); median age was 47 years (range 20–80 years). Mean TEVAR oversizing was 19.6% ± 9.7% (range 5%–35%). Following a median follow up of 67.4 ± 56.1 months (range 14–153 months) survival at one, three, six, and 10 years was 90.4% (standard error [SE] 4.1%), 88.3% (SE 4.5%) 84.8% (SE 5.5%), and 84.8% (SE 5.5%), respectively. There were no procedure/graft related complications except for one late intramural haematoma that required re-intervention. Freedom from aortic remodelling at one, six, and 10 years was 85.1% (SE 5.2%), 30.9% (SE 8.6%), and 24.7% (SE 8.8%), respectively. The increase in D1/D2 and D3 diameters were influenced by time from intervention (both p <.001), age (p <.001 and p =.002, respectively) and sealing in zone 2 (p =.027 and p =.042, respectively). For every 10% increase in oversizing, proximal neck diameter remodelling was 3.4% (p =.05). The distal axis decreased over time (p <.001; significant between three and six years). Conclusion: TEVAR is safe for BTAI in the mid to long term. This study reports a correlation between time, oversizing, and remodelling, but the level of adverse events was low.

KW - Blunt injury

KW - Endovascular technique

KW - Thoracic aorta

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UR - http://www.scopus.com/inward/citedby.url?scp=85077322616&partnerID=8YFLogxK

U2 - 10.1016/j.ejvs.2019.05.008

DO - 10.1016/j.ejvs.2019.05.008

M3 - Article

AN - SCOPUS:85077322616

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

SN - 1078-5884

ER -