title: Long-term outcomes of thoracic endovascular aortic repair: A single institution's 11-year experience.
abstract: Thoracic endovascular aortic repair (TEVAR) has largely replaced traditional open aortic repair for anatomically suitable lesions, however, long-term outcomes are unknown.
  
  
  
  All patients who underwent TEVAR from December 2004 to October 2015 at a single tertiary care institution were included. Demographics, injury pattern, operative details, outcomes, and surveillance were reviewed. Follow-up ranged from 2 to 132 months and was obtained from clinic notes and imaging reports.
  
  
  
  A total of 88 patients underwent TEVAR; all suffered from blunt mechanisms, 72.7% were men. Median age, Injury Severity Score, and Trauma and Injury Severity Score was 47 (19.7), 38 (13.5), 0. 8 (0.34). Injuries included 2% grade II, 90% grade III, and 8% grade IV. Overall mortality was 6.8%, TEVAR-related mortality was 0%. Overall in-hospital complication rate was 57%, whereas TEVAR-related complication rate was 9.1%: four typ 1a endoleaks, two typ 2, and two typ 3. Of the typ 1 endoleaks, all required reoperation, whereas all types 2 and 3 endoleaks resolved on subsequent imaging. The left subclavian artery (LSCA) was intentionally covered at index operation in 19 patients (21.6%), and 7 patients (8%) had partial LSCA coverage. The rate of postoperative left upper extremity ischemia was 0%. Left carotid-subclavian bypasses were performed prophylactically in two patients before LSCA coverage at index operation. Eighty-seven percent of endograft access was by performed by open femoral artery exposure and one via retroperitoneal conduit. Percutaneous TEVAR (pTEVAR) was performed more recently in 11.4% of patients with no complications. Heparin was administered intraoperatively in 23 patients with TBI, and 12 patients were not heparinized; no adverse events or outcomes resulted from its use or lack thereof. First, second, and third surveillance imagings occurred at mean intervals of 14 days, 4 months, and 1 year, respectively. Percent of patients followed at 1, 3, and 5 years from operation was 62.1%, 25%, 13.6%, respectively.
  
  
  
  TEVAR continues to be a feasible treatment modality for blunt traumatic aortic injury with minimal and early device and procedure-specific complications. Follow-up continues to be a significant challenge, and protocols for surveillance imaging are needed. This is the first study to describe access specific outcomes of pTEVAR in trauma patients. Long-term outcomes of TEVAR are still largely unknown; however, these data suggest that it may be at least comparable to open repair.
  
  
  
  Prognostic/epidemiologic study, level IV; therapeutic study, level V.
authors.affiliation: From the University of Maryland School of Medicine (M.B., W.T., M.H., J.O.C., D.S., T.S.), Division of Trauma/Critical Care RA Cowley Shock Trauma Center, and Division of Vascular Surgery (M.B., M.H.), University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Megan
authors.initials: M
authors.lastname: Brenner
authors.forename: William
authors.initials: W
authors.lastname: Teeter
authors.forename: Muhammed
authors.initials: M
authors.lastname: Hadud
authors.forename: Melanie
authors.initials: M
authors.lastname: Hoehn
authors.forename: James
authors.initials: J
authors.lastname: O'Connor
authors.forename: Deborah
authors.initials: D
authors.lastname: Stein
authors.forename: Thomas
authors.initials: T
authors.lastname: Scalea
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery*