Abstract 11181: Late Outcomes Following Bridge-use of Stent-Graft for Blunt Traumatic Aortic Injury in the Younger Patients

Introduction: Thoracic endovascular aortic repair (TEVAR) for the younger patients remains controversial because of anatomical characteristics of the aortic arch in youth. We have performed TEVAR as an initial treatment for traumatic aortic injury (TAI) complicated with multiple organ injuries. This study evaluated the early and late outcomes of the younger patients with this approach. Methods: Between 9/03 and 5/16, 56 patients with TAI were treated surgically, including 37 patients underwent TEVAR, 9 underwent open aortic repair (OAR), and 10 required emergent room thoracotomy (ERT), as an initial treatment. The mean age of the patients was 53.6 (SD 19.7) y/o, including 17 patients of younger patients (age under 40 y/o). The mean injury severity score (ISS) was 51.8 (SD 19.8), site of aortic injury was isthmus in 51 patients, and mode of injuries included motor vehicle crashes in 43 and falls in 13. Open aortic repair was selected if multiple organ injuries were not involved or if TEVAR was not suitable due to difficult anatomy of arch branch vessels, and ERT was performed as salvage surgery. Results: Mortality of TEVAR, OAR, ERT group was 13%, 25%, 100%, respectively. In TEVAR group, removal of the stent-graft and secondary OAR were undertaken in 22% (8/37) due to graft malfunctions. Mean time interval from TEVAR to secondary OAR was 39.5 days, and none of the patient died postoperatively. Incidence of secondary OAR was significantly higher in the younger patients (44%, 7/16) when as compared with patients over 40 y/o (2.5%, 1/40). Overall, in the younger patients, OAR was eventually undertaken in 75% (12/16), including 5 as an initial treatment and 7 as the secondary treatment. The mean follow-up periods were 61.5 (SD 25.1) months. Of 45 patients in TEVAR and OAR groups, cumulative survival rate was 78.8% in 5 years, and freedom from aortic event was achieved in 70.8% in 5 years. Conclusions: TEVAR is a safe and effective procedure as an initial treatment of TAI with multiple organ injuries. In the younger patients, TEVAR is recommended as a bridge-use to the secondary open aortic repair.