World Journal of Surgery

, Volume 40, Issue 7, pp 1763–1770 | Cite as

Late Radiological and Clinical Outcomes of Traumatic Thoracic Aortic Injury Managed with Thoracic Endovascular Aortic Repair

  • M. KhashramEmail author
  • Q. He
  • T. H. Oh
  • A. Khanafer
  • I. A. Wright
  • T. M. Vasudevan
  • A. S. N. Lo
  • J. A. Roake
  • I. Civil
Original Scientific Report



Patients treated with thoracic endovascular aortic repair (TEVAR) for traumatic thoracic aortic injury (TTAI) are often young and data on long-term durability of this treatment is not widely documented. The aims of this study were to report the New Zealand (NZ) national experience of TEVAR and to assess the durability of late outcomes and radiological follow-up of patients treated for TTAI.


Consecutive patients treated with TEVAR during a 12-year period from all tertiary centers in NZ were included. Early (30-day), late survival and radiological imaging data were recorded to document late graft-related complications and re-interventions.


88 patients with a median (range) age of 35 (15–87) year and 63 (71.6 %) males were included. Eleven patients (12.5 %) died within 30 days, of which three were aortic related deaths. The median (range) follow-up was 76.3 (0.3–164.6) months. Six (7.8 %) patients died during the follow-up period due to non-aortic-related causes. Nine (11.5 %) patients were lost to follow-up of which three emigrated overseas. Of those on surveillance, two patients required TEVAR re-intervention to previously treated aortic segments; one for a type 1b endoleak and the other for a symptomatic pseudo-coarctation. Both were treated successfully with a TEVAR.


This multicenter study suggests that TEVAR is a durable option for treatment of traumatic thoracic aortic injury. Although, stent graft complications were uncommon, but when it occurred, it leads to re-intervention. Further radiological follow-up is required particularly in young patient to document late aortic/stent complications.


Computerize Tomographic Angiography Stent Graft Thoracic Aortic Aneurysm Aortic Injury Thoracic Endovascular Aortic Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to thank the vascular surgeons, cardiothoracic surgeons, and interventional radiologists who contributed to the New Zealand Thoracic Aortic Stent Registry.


  1. 1.
    Parmley LF, Mattingly TW, Manion WC (1958) Penetrating wounds of the heart and aorta. Circulation 17:953–973CrossRefPubMedGoogle Scholar
  2. 2.
    Volodos NL (2013) Historical perspective: the first steps in endovascular aortic repair: how it all began. J Endovasc Ther 20(Suppl 1):I3–I23PubMedGoogle Scholar
  3. 3.
    Dake MD, Miller DC, Semba CP et al (1994) Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. New Eng J Med 331:1729–1734CrossRefPubMedGoogle Scholar
  4. 4.
    Murad MH, Rizvi AZ, Malgor R et al (2011) Comparative effectiveness of the treatments for thoracic aortic transection. J Vasc Surg 53:193–199CrossRefPubMedGoogle Scholar
  5. 5.
    Tang GL, Tehrani HY, Usman A et al (2008) Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: a modern meta-analysis. J Vasc Surg 47:671–675CrossRefPubMedGoogle Scholar
  6. 6.
    Lee WA, Matsumura JS, Mitchell RS et al (2011) Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg 53:187–192CrossRefPubMedGoogle Scholar
  7. 7.
    Zoli S, Trabattoni P, Dainese L et al (2012) Cumulative radiation exposure during thoracic endovascular aneurysm repair and subsequent follow-up. Eur J Cardio-Thoracic 42:254–259CrossRefGoogle Scholar
  8. 8.
    Stacul F, van der Molen AJ, Reimer P (2011) Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 21:2527–2541CrossRefPubMedGoogle Scholar
  9. 9.
    Holmes JHT, Bloch RD, Hall RA et al (2002) Natural history of traumatic rupture of the thoracic aorta managed nonoperatively: a longitudinal analysis. Ann Thorac Surg 73:1149–1154CrossRefPubMedGoogle Scholar
  10. 10.
    Brinster DR (2009) Endovascular repair of blunt thoracic aortic injuries. Sem Thorac Cardiovasc Surg 21:393–398CrossRefGoogle Scholar
  11. 11.
    Day CP, Buckenham TM (2008) Outcomes of endovascular repair of acute thoracic aortic injury: interrogation of the New Zealand thoracic aortic stent database (NZ TAS). Eur J Vasc Endovasc Surg 36:530–534CrossRefPubMedGoogle Scholar
  12. 12.
    Mitchell RS, Ishimaru S, Ehrlich MP et al (2002) First international summit on thoracic aortic endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther 9:II98–II105CrossRefPubMedGoogle Scholar
  13. 13.
    Azzizadeh A, Keyhani K, Miller CC et al (2009) Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg 49:1403–1408CrossRefGoogle Scholar
  14. 14.
    Canaud L, Alric P, Desgranges P et al (2010) Factors favoring stent-graft collapse after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 139:1153–1157CrossRefPubMedGoogle Scholar
  15. 15.
    Chiesa R, Tshomba Y, Kahlberg A et al (2010) Management of thoracic endograft infection. J Cardiovasc Surg 51:15–31Google Scholar
  16. 16.
    Patel HJ, Williams DM, Drews JD et al (2014) A 20-year experience with thoracic endovascular aortic repair. Ann Surg 260:691–696CrossRefPubMedGoogle Scholar
  17. 17.
    Jonker FHW, Schlosser FJV, Geirsson A et al (2010) Endograft collapse after thoracic endovascular aortic repair. J Endovasc Ther 17:725–734CrossRefPubMedGoogle Scholar
  18. 18.
    McBride CL, Dubose JJ, Miller CC et al (2015) Intentional left subclavian artery coverage during thoracic endovascular aortic repair for traumatic aortic injury. J Vasc Surg 61:73–79CrossRefPubMedGoogle Scholar
  19. 19.
    Wong S, Mastracci TM, Katsargyris A et al (2012) The role of mandatory lifelong annual surveillance after thoracic endovascular repair. J Vasc Surg 56:1786–1793CrossRefPubMedGoogle Scholar
  20. 20.
    Erbel R, Aboyans V, Boileau C et al (2014) ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 35:2873–2926CrossRefPubMedGoogle Scholar
  21. 21.
    Kret MR, Azarbal AF, Mitchell EL et al (2013) Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection. J Vasc Surg 58:25–31CrossRefPubMedGoogle Scholar
  22. 22.
    Kidane B, Plourde M, Chadi SA et al (2015) The effect of loss to follow-up on treatment of blunt traumatic thoracic aortic injury. J Vasc Surg 61:1624–1634CrossRefPubMedGoogle Scholar
  23. 23.
    Azizzadeh A, Charlton-Ouw KM, Chen Z et al (2013) An outcome analysis of endovascular versus open repair of blunt traumatic aortic injuries. J Vasc Surg 57:108–115CrossRefPubMedGoogle Scholar
  24. 24.
    Karmy-Jones R, Ferrigno L, Teso D et al (2011) Endovascular repair compared with operative repair of traumatic rupture of the thoracic aorta: a nonsystematic review and a plea for trauma-specific reporting guidelines. J Trauma 71:1059–1072CrossRefPubMedGoogle Scholar
  25. 25.
    Bosanquet DC, Twine CP, Tang TY et al (2015) Pragmatic minimum reporting standards for thoracic endovascular aortic repair. J Endovasc Ther 22:356–367CrossRefPubMedGoogle Scholar
  26. 26.
    Fillinger MF, Greenberg RK, McKinsey JF et al (2010) Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg 52:1022–1033CrossRefPubMedGoogle Scholar
  27. 27.
    Sincos IR, Alun R, Belczak SQ et al (2011) Endovascular and open repair for blunt aortic injury, treated in one clinical institution in Brazil: a case series. Clinics (Sao Paulo) 66:267–274CrossRefGoogle Scholar
  28. 28.
    Patel HJ, Hemmila MR, Williams DM et al (2011) Late outcomes following open and endovascular repair of blunt thoracic aortic injury. J Vasc Surg 53:615–621CrossRefPubMedGoogle Scholar
  29. 29.
    Lioupis C, MacKenzie KS, Corriveau MM et al (2012) Midterm results following endovascular repair of blunt thoracic aortic injuries. Vasc Endovasc Surg 46:109–116CrossRefGoogle Scholar
  30. 30.
    Martinelli O, Malaj A, Gossetti B et al (2013) Outcomes in the emergency endovascular repair of blunt thoracic aortic injuries. J Vasc Surg 58:832–835CrossRefPubMedGoogle Scholar
  31. 31.
    Marone EM, Kahlberg A, Tshomba Y et al (2013) Single-center experience with endovascular treatment of acute blunt thoracic aortic injuries. J Cardiovasc Surg 54:123–131Google Scholar
  32. 32.
    Piffaretti G, Benedetto F, Menegolo M et al (2013) Outcomes of endovascular repair for blunt thoracic aortic injury. J Vasc Surg 58:1483–1489CrossRefPubMedGoogle Scholar
  33. 33.
    Canaud L, Marty-Ane C, Ziza V et al (2014) Minimum 10-year follow-up of endovascular repair for acute traumatic transection of the thoracic aorta. J Thorac Cardiovasc Surg 149:825–829CrossRefPubMedGoogle Scholar
  34. 34.
    Spiliotopoulos K, Kokotsakis J, Argiriou M et al (2014) Endovascular repair for blunt thoracic aortic injury: 11-year outcomes and postoperative surveillance experience. J Thorac Cardiovasc Surg 148:2956–2961CrossRefPubMedGoogle Scholar
  35. 35.
    Azizzadeh A, Ray HM, Dubose JJ et al (2014) Outcomes of endovascular repair for patients with blunt traumatic aortic injury. J Trauma Acute Care Surgery 76:510–516CrossRefGoogle Scholar
  36. 36.
    Steuer J, Björck M, Sonesson B et al (2015) Durability of endovascular repair in blunt traumatic thoracic aortic injury: long-term outcome from four tertiary referral centers. Eur J Vasc Endovasc Surg 50:460–465CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • M. Khashram
    • 1
    Email author
  • Q. He
    • 1
  • T. H. Oh
    • 2
  • A. Khanafer
    • 1
  • I. A. Wright
    • 3
  • T. M. Vasudevan
    • 3
  • A. S. N. Lo
    • 4
  • J. A. Roake
    • 1
  • I. Civil
    • 5
  1. 1.Department of Vascular Endovascular & Transplant SurgeryChristchurch HospitalChristchurchNew Zealand
  2. 2.Department of Cardiothoracic SurgeryAuckland City HospitalAucklandNew Zealand
  3. 3.Department of Vascular SurgeryWaikato HospitalHamiltonNew Zealand
  4. 4.Department of Vascular SurgeryWellington Regional HospitalWellingtonNew Zealand
  5. 5.Department of Vascular SurgeryAuckland City HospitalAucklandNew Zealand

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