title: Minimum 10-year follow-up of endovascular repair for acute traumatic transection of the thoracic aorta.
abstract: OBJECTIVE
  Thoracic endovascular aortic repair (TEVAR) for traumatic rupture of the descending thoracic aorta seems, in the short term, to be associated with better outcomes than open repair, but long-term data are lacking.
  
  
  METHODS
  A review was conducted of a prospectively maintained database of patients who underwent TEVAR for traumatic rupture of the descending thoracic aorta in our unit, with a minimum 10-year follow-up. Follow-up computed tomography scans were performed at 1 week, 3 and 6 months, and annually thereafter. Particular attention was focused on device-related issues.
  
  
  RESULTS
  Among the 53 patients, 17 had a minimum 10-year follow-up: mean age was 45.8 ± 17 years (range: 18-78 years); 4 were women. Mean follow-up was 11.6 years (range: 10.1-13.1 years). Technical success was achieved in 100% of cases. The distribution of the proximal landing zone was zone 2 in 4 cases, zone 3 in 13 cases. A case of inadvertent coverage of supra-aortic trunks occurred intraoperatively. An early proximal type I endoleak was successfully treated by proximal implantation of an additional second stent-graft. No perioperative death was observed, and none of the patients suffered transient or permanent paraplegia, or cerebral complication. After a minimum 10-year follow-up, all patients were still alive. Follow-up computed tomography scans did not reveal any stent-graft migration or collapse, or secondary endoleaks. However, we observed that the proximal and distal aortic neck dilated to some extent, as is the natural history of the thoracic aorta. This dilation was more marked in patients aged <30 years.
  
  
  CONCLUSIONS
  Our minimum 10-year follow-up study of endovascular repair for acute traumatic transection of the thoracic aorta demonstrated that the reduction in the operative mortality rate of TEVAR, compared with open repair, lasts over time, without any device-related issues. Longer-term follow-up is necessary to determine whether the thoracic aorta expansion continues and becomes clinically significant.
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France. Electronic address: ludoviccanaud@hotmail.com.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Marty-Ané
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ziza
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Branchereau
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Alric
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D055815:Young Adult