Diameter Changes in Traumatic Aortic Injury: Implications for Stent-Graft Sizing
06 February 2020
14 April 2020
28 July 2020 (online)
Objectives The aim of this study was to compare aortic diameters from admission computed tomography angiography (CTA) scans to postoperative aortic diameters 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 TAI between February 2002 and February 2019. Concomitant organ injuries, bone fractures, blood loss, and clinical outcomes were evaluated. Aortic diameters were measured in CTA upon admission and were compared with the CTA before discharge at three different aortic levels (mid-ascending, 5 cm distal to the end of the stent graft, and at the celiac trunk level).
Results We identified 45 patients, aged 43 (first quartile; third quartile [26; 55]) years with a TAI treated by thoracic endovascular aortic repair. The most frequent cause of TAI was a car accident (n = 24). 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%). Increase of aortic diameter after stabilization was +1.7 mm (−0.6 mm; 2.5 mm; p = 0.004) at the mid-ascending 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 mm; 3.2 mm; p < 0.001) at the celiac trunk level.
Conclusion In patients with TAI, the aortic diameter is significantly reduced as compared with the aortic diameter at discharge. The reduction of aortic diameter might be caused by hemorrhagic shock and should be kept in mind for appropriate stent-graft sizing.
Tim Berger, Maximilian Kreibich, Andreas Voetsch, and Roman Gottardi conceived and designed this study.
Diaa Alaloh, Philipp Krombholz Reindl, Andreas Winkler, and Tim Berger collected and analyzed the data.
Bartosz Rylski, Martin Czerny, Friedhelm Beyersdorf, Matthias Siepe, Thomas Wolfgruber, Rainald Seitelberger, and Roman Gottardi performed the surgical procedures and contributed substantially by interpretation of the data.
All the listed authors drafted or revised the manuscript critically for important intellectual content and finally approved the version to be published. They all agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of this study are appropriately investigated and resolved.
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