Long-term outcomes of thoracic endovascular aortic repair (TEVAR): A single institution's 11-year experience.

Introduction: TEVAR has largely replaced traditional open aortic repair for anatomically suitable lesions, however, long-term outcomes are unknown. Methods: All patients who underwent TEVAR from December 2004-October 2015 at a single tertiary care institution were included. Demographics, injury pattern, operative details, outcomes, and surveillance were reviewed. Follow-up ranged from 2-132 months, and was obtained from clinic notes and imaging reports. Results: A total of 88 patients underwent TEVAR; all suffered from blunt mechanisms, 72.7% were male. Median age, ISS, TRISS was 47(19.7), 38(13.5), 0.8(0.34). Injuries included 2% grade II, 90% grade III, 8% grade IV. Overall mortality was 6.8%, TEVAR-related mortality was 0%. Overall in-hospital complication rate was 57% while TEVAR-related complication rate was 9.1%: 4 type 1a endoleaks, 2 type 2, and 2 type 3. Of the type 1 endoleaks, all required re-operation, while all type 2 and 3 endoleaks resolved on subsequent imaging. The LSCA was intentionally covered at index operation in 19 patients (21.6%), and 7 patients (8%) had partial LSCA coverage. The rate of post-operative left upper extremity ischemia was 0%. Left carotid-subclavian bypasses were performed prophylactically in 2 patients prior to LSCA coverage at index operation. 87% of endograft access was by performed by open femoral artery exposure and one via retroperitoneal conduit. Percutaneous TEVAR (pTEVAR) was performed more recently in 11.4% of patients with no complications. Heparin was administered intra-operatively in 23 patients with TBI, and 12 patients were not heparinized; no adverse events or outcomes resulted from its use or lack thereof. First, second, and third surveillance imaging occurred at mean intervals of 14 days, 4 months, and 1 year, respectively. Percent of patients followed at 1, 3, 5 years from operation was 62.1%, 25%, 13.6%. Conclusion: TEVAR continues to be a feasible treatment modality for blunt traumatic aortic injury with minimal and early device and procedure-specific complications. Follow-up continues to be a significant challenge, and protocols for surveillance imaging are needed. This is the first study to describe access specific outcomes of pTEVAR in trauma patients. Long-term outcomes of TEVAR are still largely unknown, however, this data suggests it may be at least comparable to open repair. Level of evidence: IV (C) 2017 Lippincott Williams & Wilkins, Inc.

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