Aortic Diameter Changes in Patients with Acute Traumatic Aortic Injury: Possible Implications for Stent-Graft Sizing

Objectives: Aim of this study was to compare aortic diameters from admission computed tomography angiography (CTA) scans to postoperative aortic diameters at three different aortic levels in patients with traumatic aortic injury (TAI) and evaluate the influence of substantial blood loss on aortic diameter.

Methods: The aortic databases of two tertiary university centers were retrospectively screened for patients with traumatic aortic injury between February 2002 and February 2019. Concomitant organ injuries, bone fractures, blood loss and the clinical outcomes were evaluated. Aortic diameters were measured in CTA scans upon admission and was compared to the CT scans before discharge at three different aortic levels (midascending, 5 cm distal to the end of the stent-graft and at the coeliac trunk level).

Results: We identified 45 patients (aged 43 [26–55] years) with a TAI treated by thoracic endovascular aortic repair (TEVAR). The most frequently cause of TAI was a car accident (24 [55%]). Concomitant injuries were seen in all but one patient. Bone and pelvic fractures were seen in 40 (89%) and 15 (33%) patients, respectively. Type-III aortic injury was present in 25 patients (56%). Three (0–6) packed red blood cells were transfused in median. In-hospital mortality was 2%. Increase of aortic diameter after stabilization including fluid resuscitation was +1.7 mm (–0.6 mm, 2.5 mm; p = 0.004) at the midascending aorta, +2.1 mm (0.2 mm, 3.8 mm; (p < 0.001) 5 cm distal to the stent-graft and 1.5 mm (0.5–3.2 mm; p < 0.001) at the coeliac trunk level.

Conclusion: In patients with traumatic aortic injury, the aortic diameter is significantly reduced in different aortic segments as compared to the aortic diameter in follow-up. The reduction of aortic diameter might be caused by hemorrhagic shock and should be kept in mind for appropriate stent-graft sizing.