Thoracic Branch Endoprosthesis as Safe Alternative Therapy for Blunt Traumatic Aortic Injury Requiring Zone 2 Coverage.

BACKGROUND: Blunt traumatic aortic injury (BTAI) involving the left subclavian artery (zone 2) poses a challenging problem. Thoracic branch endoprosthesis (TBE) with a left subclavian artery side branch has emerged as a novel tool for thoracic endovascular aortic repair (TEVAR) for injuries requiring a zone 2 seal. We hypothesized that TBE is a noninferior method for zone 2 BTAI repair.

DESIGN: Retrospective analysis of a prospectively collected data from National Trauma Data Bank.

METHODS: The 2017-2022 American College of Surgeons Trauma Quality Programs Participant Use File data were abstracted. Inclusion criteria were adult patients (>16 years old) who had undergone a TBE or TEVAR with an open aortic arch debranching procedure (TEVAR-DB). Patient demographics, complications (stroke, deep venous thrombosis, ventilator associated pneumonia, acute respiratory distress syndrome, Surgical Site Infection, and unplanned return to operating room), intensive care unit length of stay (ICU-LOS), and mortality were compared. Wilcoxon signed-rank tests and linear regressions were performed. Significance was P < 0.05.

RESULTS: There were 3,538 patients who sustained a traumatic aortic injury and underwent endovascular repair. Ninety-four patients met inclusion criteria (TBE (n = 61) and TEVAR-DB (n = 33)). There was no difference in gender, age, abbreviated injury scale, or Injury Severity Score between the groups. The TBE group had a significantly lower Glasgow Coma Score on presentation (TBE: 10.8 ± 5.2 vs. TEVAR-DB: 13.0 ± 4.1, P = 0.04). In addition, there was no difference in complications between the groups. On multivariate analysis, a significant association was not present between procedure type and stroke rate, ICU-LOS, or mortality.

CONCLUSION: TBE is noninferior to TEVAR-DB for the treatment of BTAI requiring a zone 2 seal. In the appropriate patient population, it may demonstrate a less invasive treatment alternative.