Aortic dilatation after endovascular repair of blunt traumatic thoracic aortic injuries

Objective: Endovascular repair of blunt traumatic thoracic aortic injuries (BTAI) has become routine at many trauma centers despite concerns regarding durability and aortic dilatation in these predominantly young patients. These concerns prompted this examination of thoracic aortic expansion after endovascular repair of a BTAI. Methods: The immediate postoperative and most recent computed tomography (CT) scans of patients who had undergone urgent endovascular repair of a BTAI and had at least 1 year of follow-up were reviewed. Diameter measurements were made at four predetermined sites: immediately proximal to the left subclavian artery (D1), immediately distal to the left subclavian artery (D2), distal extent of the endograft (D3), and 15 mm beyond the distal end of the endograft (D4). Split screens permitted direct comparison of measurements between CTs at the corresponding levels. Results: During a 6-year period (2001-2007), 21 patients (mean age, 42.9 years; range, 19-81 years) underwent endovascular repair of a BTAI, 17 with at least 1 year of follow-up (mean, 2.6 years; range, 1-5.5 years). No patients required reintervention during this period. The mean rate of dilatation for each level of the thoracic aorta in mm/year was: D1, 0.74 (95% confidence interval [CI], 0.42-1.06); D2, 0.83 (95% CI, 0.55-1.11); D3, 0.63 (95% CI, 0.37-0.89); D4, 0.47 (95% CI, 0.27-0.67). The rate of expansion of D2 differed significantly vs D4 (P = .025). Conclusions: During the first several years of follow-up, the proximal thoracic aorta dilates minimally after endovascular repair of BTAIs, with the segment just distal to the left subclavian artery expanding at a slightly greater rate. Longer-term follow-up is necessary to determine whether this expansion continues and becomes clinically significant.