Conformable Endograft as a Standard Treatment for Thoracic Endovascular Aortic Repair in Patients With Blunt Thoracic Aortic Injury.

INTRODUCTION

A consensus exists among vascular surgery societies that blunt thoracic aortic injury (BTAI) should be treated with thoracic endovascular aortic repair (TEVAR) in patients with favorable aortic anatomy. However, selecting the correct landing zones and endograft sizing remains challenging in patients with BTAI. To overcome these limitations, conformable endografts are often used for TEVAR, even in patients with BTAI. This study aimed to analyze the outcomes of these patients with respect to anatomical and technical factors.

METHODS

This retrospective study included all patients with BTAI who underwent TEVAR at a tertiary vascular center. The primary endpoint was aortic-related reintervention-free survival. Secondary endpoints were 30-day in-hospital mortality, postoperative complications, and radiological findings. Patients were divided into 2 groups: group 1, patients with a conformable endograft (cTAG Gore), and group 2, patients with a nonconformable endograft.

RESULTS

Between June 2001 and May 2019, 57 patients (50 men; mean age, 37.3 years) with BTAI received 30 (52.6%) conformable (Gore cTAG) and 27 (47.4%) nonconformable endografts. The 1-, 3-, and 5-year aortic-related reintervention-free survival was 100%, 100%, and 96.7% in group 1 and 81.4%, 81.4%, and 77.7% in group 2, respectively (p=0.03). Two postoperative type Ia endoleaks and 3 postoperative type II endoleaks were observed in group 2. The bird beak sign was noted more often in group 2 (70.4% vs 53.3, p=0.32).

CONCLUSIONS

This study, in a small cohort of patients, demonstrated that the Gore cTAG, when properly selected according to the patient's anatomy, appears to provide better outcomes after TEVAR for patients with BTAI than nonconformable devices. A bird beak sign occurred frequently in both groups and were not associated with poor outcomes. Further studies are required to confirm these findings.Clinical ImpactThis study in a small cohort of patients demonstrated that the Gore cTAG endoprosthesis, when properly selected to match the patient's anatomy, appears to result in better outcomes after TEVAR in patients with BTAI than nonconformable devices. In addition, the BBS was common in both groups of patients and was not associated with a worse outcome.