title: Endovascular repair for blunt thoracic aortic injury: 11-year outcomes and postoperative surveillance experience.
abstract: OBJECTIVE
  Surveillance for patients undergoing thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) varies. Annual chest computed tomographic angiography (CTA) is often recommended but concerns about the risks and costs have emerged. The aim of this study was to examine the optimal follow-up frequency based on 11-year outcomes and surveillance experience.
  
  
  METHODS
  Seventy-six patients with BTAI received TEVAR from May 2002 to July 2013. Demographics, cardiovascular risk factors, Injury Severity Score (ISS), types, sizes, timing, and outcomes of stent grafts were collected retrospectively.
  
  
  RESULTS
  Mean age was 39.7 years (range, 17-85 years); 8 (11%) were women. Mean ISS was 46.2 ± 18.5 (deceased, 61.0 ± 19.2; surviving, 44.2 ± 17.6; P = .023). Technical success was achieved in 71 patients (93.4%). All-cause mortality was 7 (9.2%), 1 (1.3%) of which was related to the procedure. Six were lost to follow-up (8%). To examine the effect of surveillance frequency on outcomes, after excluding the 2 most recent (<1 year) surviving patients, we arbitrarily divided the remaining 61 with stable repairs based on the timing of their follow-up: 36 underwent timely follow-up (within ± 6 months of the scheduled annual visit; clinical examination, CTA, magnetic resonance angiography, and echocardiography); 25 had delayed follow-up (>6 months after scheduled annual visit). No significant differences were found for survival, graft-related complications, need for reintervention, except for postoperative hypertension, which was higher in the first group. All surviving patients had excellent outcomes, with no cerebrovascular accidents, paraplegia, or paraparesis; the median follow-up for both groups was 3 years (interquartile range 2.0-3.5, 1.5-5.4 years).
  
  
  CONCLUSIONS
  Midterm outcomes of TEVAR for patients with stable repair after BTAI are excellent, both with timely (1.0-1.5 years) and delayed (>1.5 years) follow-up intervals after a median surveillance period of 3 years. A larger prospective randomized study could lead to a more relaxed, but equally safe surveillance schedule for these patients, lowering risks and costs.
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif. Electronic address: kspiliot@stanford.edu.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spiliotopoulos
authors.affiliation: Cardiothoracic Surgery, Evaggelismos General Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Kokotsakis
authors.affiliation: Cardiothoracic Surgery, Evaggelismos General Hospital, Athens, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Argiriou
authors.affiliation: Cardiothoracic Surgery, Evaggelismos General Hospital, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Dedeilias
authors.affiliation: Interventional Radiology, Evaggelismos General Hospital, Athens, Greece.
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Farsaris
authors.affiliation: Interventional Radiology, Evaggelismos General Hospital, Athens, Greece; Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Theodore
authors.initials: T
authors.lastname: Diamantis
authors.affiliation: Interventional Radiology, Evaggelismos General Hospital, Athens, Greece; Cardiothoracic Surgery, Evaggelismos General Hospital, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Charitos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D004452:Echocardiography; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult