Traumatic injury of the thoracic aorta treated with stent-graft: Is long-term CT angiography follow-up justified?
Introduction
Thoracic endovascular aortic repair (TEVAR) is considered the treatment of choice in blunt traumatic thoracic aorta injury due to its minimally invasive nature.1, 2, 3, 4 Short and mid-term follow-up of these patients is usually performed with annual computed tomography angiography (CTA) to evaluate for device struts breakage, migration, thrombosis, collapse, lack of proximal device–wall apposition, or endoleak.1, 5, 6, 7, 8 Most of the trauma victims are young adults with long life expectancy and the risks of cumulative ionizing radiation exposure with annual or bi-annual CTA examination are substantial.7 The aim of the present study was to report the results of long-term CTA follow-up (minimum 5 years) after TEVAR in patients with aortic injury.
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Materials and methods
The radiology records of the interventional radiology unit in the tertiary trauma care hospital after approval of the local IRB committee were reviewed. Fourteen patients underwent stent-graft (SG) insertion due to acute thoracic aortic injury between 2002 and 2008. All alert patients consented for TEVAR. The procedure was approved for unconscious patients by three physicians of the trauma team, as per institutional rules. Four had available CTA only up to 7 months post-implantation, two were
Results
Thirty-three CTA examinations performed from 64 up to 110 months (mean 76) after SG implementation were reviewed for SG follow-up to evaluate any device-related complications. The mean number of examinations per patient was 4.7 (range 2–8). The mean proximal neck diameter on last CTA was 20 mm (range 19–24 mm) and the distal 22 mm (range 17–22 mm).
CTA did not show any of the following findings indicating device struts breakage, migration, collapse, stenosis, or thrombosis. Stable proximal lack
Discussion
Treatment of acute traumatic aortic injury has shifted from surgery to endovascular SG over the last decade due to the decreased morbidity and mortality and the minimally invasive nature of this procedure compared to open surgical repair.2, 6, 7 To the authors' knowledge, there are no published data focusing on the long-term (>5 years) CTA follow-up of these patients. Therefore, the aim of the present study was to report the results of long-term CTA follow-up.
Currently, there are several small
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One-year results of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial)
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