Long-Term Outcomes of Endovascular Versus Open Repair for Traumatic Thoracic Aortic Injury: A Single-Center Experience.

BACKGROUND

Traumatic thoracic aortic injury (TTAI) carries high early mortality. Thoracic endovascular aortic repair (TEVAR) has increasingly replaced open repair; however, long-term comparative data remain limited. This study compared long-term outcomes after open repair versus TEVAR for TTAI.

METHODS

This single-center retrospective cohort study included 95 consecutive patients with TTAI treated between January 2003 and August 2024. Patients with traumatic ascending aortic injury, those managed nonoperatively, or those not undergoing repair were excluded. Forty-two patients underwent open repair, and 53 underwent TEVAR. Primary end points were procedure-related complications and in-hospital mortality. Secondary end points were long-term all-cause and aorta-related mortality and aorta-related event rates.

RESULTS

The mean follow-up duration was 129.3 ± 58.8 months. Age and injury severity score were similar between groups. Postoperative acute kidney injury (47.6% vs. 18.9%; P = 0.003) and bowel ischemia (7.1% vs. 0.0%; P = 0.048) occurred more frequently after open repair. One patient (2.4%) in the open repair group developed spinal cord ischemia; no cases occurred after TEVAR. Rates of cerebral complications (4.8% vs. 1.9%; P = 0.445) and in-hospital mortality (7.1% vs. 11.3%; P = 0.490) did not differ significantly between open repair and TEVAR. Long-term cumulative all-cause mortality (21.4% vs. 18.9%; P = 0.915) and aorta-related mortality (2.4% vs. 1.9%; P = 0.868) were comparable, as were freedom from aorta-related events (P = 0.813).

CONCLUSION

Open repair for TTAI was associated with higher procedure-related morbidity, particularly acute kidney injury and bowel ischemia, whereas long-term survival and aorta-related event rates were similar between open repair and TEVAR. These findings support the use of TEVAR as the preferred treatment modality when anatomically feasible, although larger multicenter studies are needed to better define its long-term efficacy.