1
|
Starnes BW, Rajani RR, Rossi P, Singh N, Benarroch-Gampel J, Cho JS, Nassiri N, Smeds MR, Kalapatapu V, Stern JR, Kabutey NK, Corvera J. Early survival benefit of a low-profile endograft in blunt traumatic aortic injury. J Vasc Surg 2024:S0741-5214(24)01077-2. [PMID: 38677660 DOI: 10.1016/j.jvs.2024.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE The aim of this study was to demonstrate the safety and effectiveness of a low-profile thoracic endograft (19-23 French) in subjects with blunt traumatic aortic injury. METHODS A prospective, multicenter study assessed the RelayPro thoracic endograft for the treatment of traumatic aortic injury. Fifty patients were enrolled at 16 centers in the United States between 2017 and 2021. The primary endpoint was 30-day all-cause mortality. RESULTS The cohort was mostly male (74%), with a mean age of 42.4 ± 17.2 years, and treated for traumatic injuries (4% Grade 1, 8% Grade 2, 76% Grade 3, and 12% Grade 4) due to motor vehicle collision (80%). The proximal landing zone was proximal to the left subclavian artery in 42%, and access was primarily percutaneous (80%). Most (71%) were treated with a non-bare stent endograft. Technical success was 98% (one early type Ia endoleak). All-cause 30-day mortality was 2% (compared with an expected rate of 8%), with an exact two-sided 95% confidence interval [CI] of 0.1%, 10.6% below the performance goal upper limit of 25%. Kaplan-Meier analysis estimated freedom from all-cause mortality to be 98% at 30 days through 4 years (95% CI, 86.6%-99.7%). Kaplan-Meier estimated freedom from major adverse events, all-cause mortality, paralysis, and stroke, was 98.0% at 30 days and 95.8% from 6 months to 4 years (95% CI, 84.3%-98.9%). There were no strokes and one case of paraplegia (2%) during follow-up. CONCLUSIONS RelayPro was safe and effective and may provide an early survival benefit in the treatment of blunt traumatic aortic injury.
Collapse
Affiliation(s)
| | - Ravi R Rajani
- Department of Surgery, Emory University School of Medicine and Grady Health System, Atlanta, GA
| | - Peter Rossi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Niten Singh
- Department of Surgery, Harborview Medical Center, Seattle, WA
| | | | - Jae S Cho
- Department of Surgery, University Hospitals Cleveland, Cleveland, OH
| | - Naiem Nassiri
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | - Venkat Kalapatapu
- Department of Surgery, Penn Presbyterian Medical Center, Philadelphia, PA
| | | | | | - Joel Corvera
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| |
Collapse
|
2
|
Yeh CH, Li JY. Traumatic blunt aortic injury: experience in one hospital. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_232_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
3
|
Deng H, Tang TX, Tang LS, Chen D, Luo JL, Dong LM, Gao SH, Tang ZH. Thoracic Spine Fractures with Blunt Aortic Injury: Incidence, Risk Factors, and Characteristics. J Clin Med 2021; 10:jcm10225220. [PMID: 34830504 PMCID: PMC8623488 DOI: 10.3390/jcm10225220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The coexistence of thoracic fractures and blunt aortic injury (BAI) is potentially catastrophic and easy to be missed in acute trauma settings. Data regarding patients with thoracic fractures complicated with BAI are limited. Methods: The authors conducted a prospective, observational, single-center study including patients with thoracic burst fractures. A multivariate logistic regression model was developed to determine the risk factors of aortic injury. Results: In total, 124 patients with burst fractures of the thoracic spine were included. The incidence of BAI was 11.3% (14/124) in patients with thoracic burst fractures. Among these patients, 11 patients with BAI were missed diagnoses. The main risk factors of BAI were as follows: Injury severity score (OR 1.184; 95% CI, 1.072–1.308; p = 0.001), mechanism of injury, such as crush (OR 10.474; 95% CI, 1.905–57.579; p = 0.007), flail chest (OR = 4.917; 95% CI, 1.122–21.545; p = 0.035), and neurological deficit (OR = 8.299; 95% CI, 0.999–68.933; p = 0.05). Conclusions: BAI (incidence 11.3%) is common in patients with burst fractures of the thoracic spine and is an easily missed diagnosis. We must maintain a high suspicion of injury for BAI when patients with thoracic burst fractures present with these high-risk factors.
Collapse
Affiliation(s)
- Hai Deng
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Ting-Xuan Tang
- Class 1901, School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, China;
| | - Liang-Sheng Tang
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Deng Chen
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Jia-Liu Luo
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Li-Ming Dong
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Si-Hai Gao
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Correspondence: (S.-H.G.); (Z.-H.T.); Tel.: +86-27-83665306 (Z.-H.T.)
| | - Zhao-Hui Tang
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
- Correspondence: (S.-H.G.); (Z.-H.T.); Tel.: +86-27-83665306 (Z.-H.T.)
| |
Collapse
|
4
|
Endovascular repair of traumatic aortic isthmic rupture: Early and mid-term results. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:254-259. [PMID: 32862982 DOI: 10.1016/j.jdmv.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture. METHODS This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture. RESULTS Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14-66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18-36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5-96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported. CONCLUSION TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.
Collapse
|
5
|
Takahashi H, Shoko T, Taketazu F, Kuriyama K, Yoshikawa K, Deguchi Y. A case of paraplegia that developed 6 years after thoracic endovascular aortic repair for blunt traumatic aortic injury. Acute Med Surg 2017; 5:106-109. [PMID: 29445509 PMCID: PMC5797837 DOI: 10.1002/ams2.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/06/2017] [Indexed: 11/15/2022] Open
Abstract
Case Thoracic endovascular aortic repair (TEVAR) is becoming the standard therapy for blunt thoracic aortic injury (BTAI). However, the long‐term outcomes of TEVAR for BTAI remain unclear. A 36‐year‐old man was admitted to our emergency department with dyspnea. He had been involved in a serious traffic accident 6 years earlier, requiring TEVAR for BTAI. Outcome Acute heart failure and pneumonia were diagnosed on this admission. His respiratory condition improved, but paraplegia developed 10 h after hospitalization. Magnetic resonance imaging showed an intraspinal longitudinal area of signal hyperintensity, and spinal cord infarction was diagnosed. Conclusion Although the causal relationship between the TEVAR and spinal cord infarction remains unclear, paraplegia as a long‐term complication after TEVAR does not appear to have been reported previously, and so represents a potentially important complication.
Collapse
Affiliation(s)
- Hiroyuki Takahashi
- Department of Emergency and Critical Care Medicine Tokyo Women's Medical University Medical Center East Tokyo Japan
| | - Tomohisa Shoko
- Department of Emergency and Critical Care Medicine Tokyo Women's Medical University Medical Center East Tokyo Japan
| | - Fumino Taketazu
- Department of Emergency and Critical Care Medicine Tokyo Women's Medical University Medical Center East Tokyo Japan
| | - Keiichi Kuriyama
- Department of Emergency and Critical Care Medicine Tokyo Women's Medical University Medical Center East Tokyo Japan
| | - Kazuhide Yoshikawa
- Department of Emergency and Critical Care Medicine Tokyo Women's Medical University Medical Center East Tokyo Japan
| | - Yoshizumi Deguchi
- Department of Emergency and Critical Care Medicine Tokyo Women's Medical University Medical Center East Tokyo Japan
| |
Collapse
|
6
|
Abdoli S, Ham SW, Wilcox AG, Fleischman F, Lam L. Symptomatic Intragraft Thrombus following Endovascular Repair of Blunt Thoracic Aortic Injury. Ann Vasc Surg 2017; 42:305.e7-305.e12. [PMID: 28389290 DOI: 10.1016/j.avsg.2016.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/23/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) can be complicated by graft collapse, endoleaks, and stent migration. The incidence of these complications and other outcomes is poorly understood in young trauma victims who receive endovascular aortic repair of blunt thoracic aortic injury (BTAI). A 29-year-old pedestrian was struck by a vehicle resulting in polytrauma including BTAI with transection distal to the left subclavian artery origin. The patient underwent successful TEVAR. Nine months later, the patient developed transient paresthesia below the waist that progressed to bilateral lower extremity paralysis and malperfusion syndrome below the diaphragm including nonpalpable pulses in the lower extremities, acute renal failure, and ischemic colitis. Imaging demonstrated near occlusive thrombosis of the distal end of the thoracic endograft. An emergent axillobifemoral bypass resolved the organ malperfusion and acute limb ischemia. Patients who have undergone TEVAR for BTAI may develop asymptomatic or symptomatic intragraft thrombosis. In patients presenting with malperfusion syndrome below the diaphragm, extra-anatomic bypass can expeditiously resolve symptoms until definitive treatment can be performed. Oversizing of thoracic stents in trauma patient may lead to intragraft thrombosis.
Collapse
Affiliation(s)
- Sherwin Abdoli
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Sung Wan Ham
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Alison G Wilcox
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Fernando Fleischman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Lydia Lam
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
| |
Collapse
|