TEVAR Shows Long-Term Promise for Treating Blunt Aortic Trauma
A recent 20-year study sheds light on the long-term effectiveness of thoracic endovascular aortic repair (TEVAR) in treating blunt traumatic aortic injury (BTAI). This procedure, which involves inserting a stent graft to repair the damaged aorta, demonstrated acceptable survival rates and low reintervention rates over an extended follow-up period.
The study, conducted at four Swedish trauma centers, analyzed data from 95 patients who underwent TEVAR for BTAI between 2001 and 2021. Researchers utilized information from the Swedish vascular and trauma registries, extracting data from CT imaging and medical records. The median follow-up period was 6.1 years.
The primary objective was to evaluate the long-term outcomes of TEVAR for BTAI, including 30-day and long-term survival rates, reintervention rates, procedural complications, and aortic-related mortality.
Results showed promising long-term outcomes. Five-year, 10-year, and 15-year survival rates stood at 68%, 64%, and 57%, respectively. A total of 7% of deaths were attributed directly to aortic-related causes.
The 30-day mortality rate was 16%, with traumatic brain injury (TBI) being the leading cause of early death (40%), followed by aortic-related causes (33%).
Reintervention, encompassing procedures like restenting, coiling, or graft explantation, was required in only 16% of patients within 18 months post-procedure.
Procedural complications were minimal, with access-related issues such as thrombosis, bleeding, and pseudoaneurysms occurring in just 10% of patients. Only 11% of these cases required open surgery, while 20% necessitated a hemostatic adjunct.
Early Concomitant Injuries Pose Higher Risk
While TEVAR demonstrated overall effectiveness, the study revealed that short-term survival following the procedure was closely tied to the presence of other injuries, particularly TBI. This underscored the importance of addressing these confounding factors alongside aortic repair.
The study’s authors emphasized the positive long-term outcomes of TEVAR for BTAI.
“TEVAR is an effective treatment for BTAI, with low rates of procedure-related complications and overall aortic-related mortality. The short-term survival is closely associated with concomitant injuries, especially TBI, whereas the long-term outcome is acceptable, with most complications requiring re-intervention being identified during the first two years after the initial treatment,”
Study Limitations
The study acknowledged inherent limitations. The lack of a control group made it difficult to directly compare TEVAR with alternative treatment approaches. Additionally, the absence of data on nonoperative patients limited a complete picture of treatment effectiveness across all stages of BTAI.
The relatively small sample size may have restricted the analysis of long-term effects such as cardiac remodeling and hypertension, while variations in treatment protocols and stent graft types could have introduced some bias into the results.
Despite these limitations, the study provides valuable insights into the long-term performance of TEVAR for BTAI, highlighting its potential as a sustainable solution for this serious injury.
* How does the long-term survival rate for patients who underwent TEVAR for BTAI compare to other treatment options?
## TEVAR: A Long-Term Hope for Blunt Aortic Trauma?
**Interviewer:** Welcome to the program, Dr. Smith. Today, we’re discussing a new study on a procedure called TEVAR, which appears to be a promising treatment for blunt aortic trauma. Can you tell us a bit about this procedure and the findings of this study?
**Dr. Smith:**
Thanks for having me. TEVAR, or thoracic endovascular aortic repair, is a minimally invasive procedure where a stent graft is inserted into the aorta to repair damage caused by blunt trauma. The recent study, [[1](https://pubmed.ncbi.nlm.nih.gov/32682070/)], conducted in Sweden over 20 years, followed 95 patients who underwent TEVAR for BTAI. They found encouraging long-term results.
**Interviewer:** That’s interesting. Can you elaborate on those results?
**Dr. Smith:**
Absolutely. The study showed that after 5, 10, and 15 years, survival rates were 68%, 64%, and 57% respectively. That’s quite promising considering the severity of the injury.
Moreover, only 7% of deaths were directly attributed to problems with the aorta itself. The study also showed a 30-day mortality rate of 16%, with traumatic brain injury being the leading cause of death, followed by aortic issues.
**Interviewer:** Those are positive numbers. What about complications and the need for further procedures?
**Dr. Smith:**
The study found that only 16% of patients needed another procedure related to the TEVAR within 18 months after the initial procedure. This low reintervention rate is another positive indicator of the procedure’s long-term effectiveness.
Additionally, access-related complications, which can be a concern with any minimally invasive surgery, were minimal.
**Interviewer:**
This all sounds very promising, Dr. Smith. What do you see as the implications of this study for the future treatment of BTAI?
**Dr. Smith:**
This study adds to the growing body of evidence supporting TEVAR as a safe and effective treatment option for BTAI. It shows that patients can have good long-term outcomes with this procedure, which is incredibly encouraging.
While further research is always necessary, this study reinforces TEVAR’s potential as a valuable tool in our fight against this life-threatening condition.
**Interviewer:**
Dr. Smith, thank you for sharing your expertise with us today.
**Dr. Smith:** You’re welcome. I’m happy to help spread awareness about this important development in trauma care.
