Thoracic Endovascular Aortic Repair for Penetrating Aortic Trauma

Background: Thoracic endovascular aortic repair (TEVAR) reduced mortality for blunt aortic injury (BAI) from 30-50% to < 10%; however, traumatic penetrating aortic injury (PAI) remains highly lethal (>40% mortality). This study's goal is to determine outcomes of TEVAR for PAI. Methods: Patients undergoing TEVAR for traumatic aortic injuries were identified from the Vascular Quality Initiative database from 2011 to 2022. Patients with blunt and penetrating injuries were compared based on preoperative characteristics, injury severity, and postoperative outcomes. Results: TEVAR was performed for 1,867 patients with traumatic aortic injuries, of which 1,808 (96.9%) patients had BAI and 59 (3.1%) had PAI. The majority of injuries being treated were either grade 3 (pseudoaneurysm) (55.3%) or grade 4 (transection) (16.4%). PAI patients had a higher proportion of grade 4 injuries compared to BAI (36.4% vs. 16.5%, P - 0.001). The majority of PAI were in zones 4-5 (61.1% vs. 14.2%, P < 0.001), whereas the majority of BAI were in zone 3 (66.5% vs. 16.7%, P < 0.001). Overall, the mortality rate was 8.2% (N - 154). In hospital mortality was 8.5% in the PAI group and 8.2% in the BAI group (P - 0.813). There was no significant difference in major complication rates between PAI and BAI patients. Conclusion: PAI occurs more commonly in zones 4-5 of the thoracic aorta and often presents with higher grade aortic injury when compared to BAI. TEVAR for PAI provides excellent inhospital survival, especially compared to historical mortality rates around 40%. An endovascular first approach may lead to improved survival for PAI.