@article{3110385,
    title = "Endovascular repair for blunt thoracic aortic injury: 11-year outcomes and postoperative surveillance experience",
    author = "Spiliotopoulos, K. and Kokotsakis, J. and Argiriou, M. and Dedeilias, P. and Farsaris, D. and Diamantis, T. and Charitos, C.",
    journal = "Korean Journal of Thoracic and Cardiovascular Surgery",
    year = "2014",
    volume = "148",
    number = "6",
    pages = "2956-2961",
    publisher = "Mosby Year Book Inc",
    doi = "10.1016/j.jtcvs.2014.08.019",
    keywords = "adolescent;  adult;  aged;  aorta injury;  Article;  blunt thoracic aortic injury;  cardiovascular risk;  clinical examination;  computed tomographic angiography;  echocardiography;  endovascular aneurysm repair;  female;  follow up;  human;  injury scale;  magnetic resonance angiography;  major clinical study;  male;  mortality;  outcome assessment;  postoperative period;  survival;  aortography;  blood vessel transplantation;  computer assisted tomography;  endovascular surgery;  Kaplan Meier method;  middle aged;  Postoperative Complications;  predictive value;  procedures;  proportional hazards model;  retrospective study;  risk factor;  thoracic aorta;  Thoracic Injuries;  time;  treatment outcome;  Vascular System Injuries;  very elderly;  Wounds, Nonpenetrating;  young adult, Adolescent;  Adult;  Aged;  Aged, 80 and over;  Aorta, Thoracic;  Aortography;  Blood Vessel Prosthesis Implantation;  Echocardiography;  Endovascular Procedures;  Female;  Humans;  Injury Severity Score;  Kaplan-Meier Estimate;  Magnetic Resonance Angiography;  Male;  Middle Aged;  Postoperative Complications;  Predictive Value of Tests;  Proportional Hazards Models;  Retrospective Studies;  Risk Factors;  Thoracic Injuries;  Time Factors;  Tomography, X-Ray Computed;  Treatment Outcome;  Vascular System Injuries;  Wounds, Nonpenetrating;  Young Adult",
    abstract = "Objective Surveillance for patients undergoing thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) varies. Annual chest computed tomographic angiography (CTA) is often recommended but concerns about the risks and costs have emerged. The aim of this study was to examine the optimal follow-up frequency based on 11-year outcomes and surveillance experience.
© 2014 The American Association for Thoracic Surgery Methods Seventy-six patients with BTAI received TEVAR from May 2002 to July 2013. Demographics, cardiovascular risk factors, Injury Severity Score (ISS), types, sizes, timing, and outcomes of stent grafts were collected retrospectively.
Results Mean age was 39.7 years (range, 17-85 years); 8 (11%) were women. Mean ISS was 46.2 ± 18.5 (deceased, 61.0 ± 19.2; surviving, 44.2 ± 17.6; P =.023). Technical success was achieved in 71 patients (93.4%). All-cause mortality was 7 (9.2%), 1 (1.3%) of which was related to the procedure. Six were lost to follow-up (8%). To examine the effect of surveillance frequency on outcomes, after excluding the 2 most recent (<1 year) surviving patients, we arbitrarily divided the remaining 61 with stable repairs based on the timing of their follow-up: 36 underwent timely follow-up (within ±6 months of the scheduled annual visit; clinical examination, CTA, magnetic resonance angiography, and echocardiography); 25 had delayed follow-up (>6 months after scheduled annual visit). No significant differences were found for survival, graft-related complications, need for reintervention, except for postoperative hypertension, which was higher in the first group. All surviving patients had excellent outcomes, with no cerebrovascular accidents, paraplegia, or paraparesis; the median follow-up for both groups was 3 years (interquartile range 2.0-3.5, 1.5-5.4 years).
Conclusions Midterm outcomes of TEVAR for patients with stable repair after BTAI are excellent, both with timely (1.0-1.5 years) and delayed (>1.5 years) follow-up intervals after a median surveillance period of 3 years. A larger prospective randomized study could lead to a more relaxed, but equally safe surveillance schedule for these patients, lowering risks and costs."
}