Long-Term Outcomes of Thoracic Endovascular Aortic Repair Focused on Bird Beak and Oversizing in Blunt Traumatic Thoracic Aortic Injury.

BACKGROUND: The acute aortic arch angle and narrow aortic diameter in young patients may lead to bird-beak configuration and excessive oversizing of the stent graft in thoracic endovascular aortic repair (TEVAR) for blunt traumatic thoracic aortic injury (BTTAI). Little is known about the association of these factors and complications in long-term follow-up. We evaluated the long-term outcomes in terms of complications, reinterventions, and survival, focusing on the effects of bird-beak configuration and oversizing.

METHODS: This prospective cohort study included patients who underwent TEVAR for BTTAI in our department between October 1999 and January 2015. The main outcomes were migration, collapse, intragraft mural thrombus, reintervention, and survival and their association with oversizing and bird-beak configuration.

RESULTS: Thirty-four patients were included. Median age was 36 years, and 21% were women. Mean graft oversizing was 19% (range: 8-27%) at the proximal end and 27% (range:, -20% to 50%) at the distal end. Mean follow-up was 98 months (12-198 months). Seven patients presented intragraft mural thrombus, one of whom developed an occlusive parietal thrombosis 1 year after the procedure. Four patients (9%) required reintervention: postoperative revascularization of the left subclavian artery in 2 cases and aortic reinterventions in 2 others. No migration or mortality was seen during follow-up. Bird-beak configuration was seen in 65%: the mean protrusion extension was 16 mm (standard deviation [SD]: 7.4 mm) and the mean angle was 51° (SD: 16°). The association between the complications and bird beak was not statistically significant. Patients with complications had significantly higher proximal end oversizing (23%) than the group with no complications (17%) (P = 0.0007).

CONCLUSIONS: TEVAR for BTTAI shows good results in the long-term follow-up. Complications in our series seemed related to proximal end oversizing. Thoracic stent grafts with a smaller diameter should be available in all trauma centers to avoid excessive oversizing.