1Vinay Kumar Dp

1Southmead Hospital, Bristol, United Kingdom

Background:

This case series aim to highlight the safe and swift endovascular solution in the management of traumatic thoracic aortic injury.

Material(s) and Method(s):

Total patients – 5 in a period between January 2019 to December 2020. CT angiography was performed in all cases which allowed evaluation for the grade of injury (Azizzadeh’s grade) and stent sizing. Two of the lesions were grade 4 and three were grade 3. In terms of lesions location 3 were involving isthmus and two involved distal descending thoracic aorta.  All interventions performed in hybrid theatre with a vascular surgeon to allow provision for surgical groin exposure if needed. All patients received general anaesthesia.

Result(s):

Technical success was achieved in all patients with precise landing of stents. Mean procedure time- 45.4 minutes. CT angiogram performed before discharge with a protocol to follow up at 3 and 6 months and annually thereafter if no complications. The mean follow-up period is 14.5 months (range, 1.5–22). During the follow-up period, CT scan showed complete exclusion of the aortic injury in all patients and there were no stent graft-related complications. All 5 patients are alive at present with no re-interventions.

Conclusion(s):

With advent of new thoracic endovascular stent grafts which allow easy repositioning and excellent conformability along with accumulating long term data, TEVAR should be first-line repair method for TTAI. Having an established regional multi-trauma pathway to facilitate triage and access to specialist care is key to success. We found that TEVAR (Thoracic endovascular repair) is a procedure which can be performed in a short time but needs expertise.