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Rule of four: an anatomic and value-based approach to stent-graft inventory for blunt thoracic aortic injury

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

As blunt thoracic aortic injury (BTAI) treatment has shifted from open to thoracic endovascular aortic repair (TEVAR), logistical challenges exist in creating and maintaining inventories of appropriately sized stent-grafts, including storage demands, shelf-life management and cost. We hypothesized that most injured aortas can be successfully repaired with a narrow range of stent-graft sizes and present a value-based anatomic approach to optimizing inventory.

Methods

CT-scans of all patients with BTAI admitted to our Level I trauma center from Apr 2010-Dec 2018 were reviewed. Patients with anatomy incompatible with TEVAR were excluded. For each patient, after aortic sizing a set of two stent-grafts most likely to be utilized was selected from a list of twenty commercially available GORE conformable TAG endografts based on manufacturer instructions. Stent-graft sizes were then ranked based on the number of cases they would be suitable for. MATLAB was utilized to determine the combinations of stent-grafts which would cover the most patients.

Results

Twenty-eight patients with BTAI were identified and three were excluded based on iliac diameter. Most patients were male (68%), mean age 42.3 ± 20.2 years, mean ISS 37.0 ± 9.8. Overall mortality was 25%. Of the 20 available stent-graft options, a combination of four stent-grafts would successfully treat 100% of the patients in this series.

Conclusions

Based on actual CT-scan aortic measurements, we demonstrated that an inventory of four sent-graft sizes was sufficient to treat 100% of patients with BTAI. These data can be utilized as a value-based anatomic approach to aortic stent-graft institutional inventory creation and maintenance.

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Author information

Author notes

  1. C. Yvonne Chung

    Present address: R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA

Authors and Affiliations

  1. Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, 1500 Red River Street, Annex, Austin, TX, 78701, USA

    Kristofor A. Olson, C. Yvonne Chung, Charles E. Hill, Carlos V. R. Brown & Pedro G. Teixeira

  2. Department of Mathematics and Statistics, UiT–The Arctic University of Norway, Tromsø, Norway

    Nikolas O. Aksamit

Authors
  1. Kristofor A. Olson
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  2. C. Yvonne Chung
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  3. Nikolas O. Aksamit
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  4. Charles E. Hill
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  5. Carlos V. R. Brown
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  6. Pedro G. Teixeira
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Corresponding authors

Correspondence to Kristofor A. Olson or Pedro G. Teixeira.

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The authors have no conflicts of interest to declare.

Supplementary Information

Below is the link to the electronic supplementary material.

68_2023_2267_MOESM1_ESM.xlsx

Supplementary Table I. Raw output of stent-graft combinations. Stent # 1 (21mm), 2 (26/21 mm), 3 (26 mm), 4 (28 mm), 5 (31/26 mm), 6 (31 mm), 7 (34 mm) (XLSX 17 KB)

Supplementary Figure I (Worksheet for analysis of aortic dimensions for stent-graft selection.) (PDF 143 KB)

Supplementary file3 (MAT 0 KB)

Supplementary file4 (M 2 KB)

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Olson, K.A., Chung, C.Y., Aksamit, N.O. et al. Rule of four: an anatomic and value-based approach to stent-graft inventory for blunt thoracic aortic injury. Eur J Trauma Emerg Surg 49, 2173–2176 (2023). https://doi.org/10.1007/s00068-023-02267-z

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  • DOI: https://doi.org/10.1007/s00068-023-02267-z

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