Thoracic endovascular aortic repair for traumatic and non-traumatic rupture of the descending thoracic aorta: A 15-year single-centre experience

TL;DR

This study examines the outcomes of aortic repair surgery for traumatic and non-traumatic aortic ruptures over 15 years, finding better survival rates in traumatic cases.

Contribution

The study provides long-term outcome data for TEVAR in traumatic and non-traumatic aortic ruptures, identifying survival factors.

Findings

Traumatic rupture patients had significantly better survival rates compared to non-traumatic rupture patients.

Non-traumatic rupture patients had more long-term aortic complications and higher mortality rates.

Age, hypertension, complications, and rupture cause significantly affected survival.

Abstract

Ruptures of the descending thoracic aorta are life-threatening emergencies with traumatic and non-traumatic causes. Thoracic endovascular aortic repair (TEVAR) has become a key treatment, but long-term outcome data remain limited. This study aimed to review our experience with TEVAR in patients with traumatic or non-traumatic rupture and identify factors associated with post-TEVAR survival.

Between 2001 and 2016, 56 patients (21 with traumatic rupture and 35 with non-traumatic rupture) underwent TEVAR at the West-German Heart and Vascular Center Essen, Germany. Data examined included demographics, comorbidities, biomarker levels, imaging results, intervention details, complications, and outcomes (30 days and follow-up).

Patients with non-traumatic rupture were significantly older and had more cardiovascular comorbidities. Patients with traumatic rupture presented more frequently with hemodynamic shock and mediastinal hematoma (47 %). Left subclavian artery coverage was more common in traumatic rupture (57.1 % vs. 18.2 %). Long-term aortic complications were more frequent in non-traumatic rupture (33.3 % vs. 0 %). Patients with traumatic rupture showed significantly longer survival. The overall 30-day mortality was 14.3 % (4.7 % in traumatic rupture patients vs. 20 % in non-traumatic rupture patients) and long-term mortality was 64.5 % (33.3 % in traumatic rupture patients vs. 84.2 % in non-traumatic rupture patients). Age, hypertension, complications, and the aetiology of aortic rupture significantly affected survival.

Patients with traumatic aortic rupture are younger, have healthier vessels, and show better outcomes after TEVAR. This may allow longer follow-up intervals in selected cases, while closer monitoring remains necessary for non-traumatic ruptures.

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