Endovascular Repair in Blunt Thoracic Aortic Injury, Experience from Ramathibodi Hospital, Thailand

Parinya Leelayana, Siam Khajarern, Piya Cherntanomwong, Narongrit Kantathut

Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–A

Abstract

Objective: Blunt thoracic aortic injury (BTAI) is associated with high morbidity and mortality. Current standard practice recommended endovascular repair over open surgical repair, especially in patients with suitable anatomy. We reviewed our center experiences with endovascular repair of BTAI.

Methods: Medical records of patients with BTAI treated with endovascular repair in the past 4 years at Ramathibodi Hospital were reviewed. Baseline demographic data, Injury Severity Score (ISS) at index events, procedure details and follow-up evaluation of clinical symptoms and imaging were obtained and analyzed.

Results: From September 2014 to May 2017, 8 patients (6 men, 2 women) with median age of 37 years (range 13 to 75), and median ISS of 29.5 (range 20 to 68), were diagnosed with BTAI. Seven of them underwent uneventful endovascular repair, while one patient experienced iatrogenic cardiac tamponade from right atrium injury during central venous catheter insertion via right internal jugular vein. All procedures were done under general anesthesia, and none of the patients received heparin due to multiple co-trauma. Endovascular stent grafts covered left subclavian arteries in 7 of 8 patients. There was no immediate complication in term of dead, post-procedural stroke or paraplegia as well as no symptom of left arm claudication or ischemia was reported. Median follow-up duration was 7 months (range 1 to 37), with at least one computerized tomography angiography (CTA) performed in each patient. Neither endoleak nor stent migration were documented.

Conclusions: Despite the small number of patients at our center, endovascular repair of BTAI seemed to be safe and had satisfactory outcomes. However, further long-term follow-up is needed for evaluation of durability and late complications.