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First Use of GORE TAG Thoracic Endograft with Active Control System in Traumatic Aortic Rupture.

ABSTRACT: Patients after a high-velocity motor vehicle collision with rapid deceleration are at a significant risk of blunt aortic injury, a life-threatening condition that usually occurs in the aortic isthmus. Aortic transection is the second leading cause of death behind head injury for individuals aged 4 to 34. During the last two decades, there has been a shift from open towards the endovascular repair. Significant progress has been made recently in terms of the design of both the stent graft and the delivery system. We herein present the case of a female patient under dual antiplatelet therapy for coronary artery disease, with type IV blunt aortic injury (rupture) that was successfully repaired with Conformable Thoracic Endograft with Active Control System. This new device provides an intermediate deployment step at 50% and optional angulation control of the proximal part of the stent graft. These improvements are beneficial providing accurate device placement and maximum seal length in anatomies where the distal, as well as a proximal landing zone, is critical.

SUBMITTER: Eforakopoulos F

PROVIDER: S-EPMC7426760 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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First Use of GORE TAG Thoracic Endograft with Active Control System in Traumatic Aortic Rupture.

Eforakopoulos Fotios F Akrida Ioanna I Zampakis Petros P Katsanos Konstantinos K Papadopoulos Panagiotis P Koletsis Efstratios E

Case reports in surgery 20200805

Patients after a high-velocity motor vehicle collision with rapid deceleration are at a significant risk of blunt aortic injury, a life-threatening condition that usually occurs in the aortic isthmus. Aortic transection is the second leading cause of death behind head injury for individuals aged 4 to 34. During the last two decades, there has been a shift from open towards the endovascular repair. Significant progress has been made recently in terms of the design of both the stent graft and the ...[more]

PMID: 32832188

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Project description:Endovascular repair of traumatic thoracic aortic injuries (TTAI) is an alternative to conventional open surgical repair. Single-institution studies have shown a survival benefit with thoracic endovascular aortic repair (TEVAR), but whether this is being realized nationally is not clear. The purpose of our study was to document trends in the increase in use of TEVAR and its effect on outcomes of TTAI nationally.Patients admitted with a TTAI between 2005 and 2011 were identified in the National Inpatient Sample. Patients were grouped by treatment into TEVAR, open repair, or nonoperative management. Primary outcomes were relative use over time and in-hospital mortality. Secondary outcomes included postoperative complications and length of stay. Multivariable logistic regression was performed to identify independent predictors of mortality.Included were 8384 patients, with 2492 (29.7%) undergoing TEVAR, 848 (10.1%) open repair, and 5044 (60.2%) managed nonoperatively. TEVAR became the dominant treatment option for TTAI during the study period, starting at 6.5% of interventions in 2005 and accounting for 86.5% of interventions in 2011 (P < .001). Nonoperative management declined concurrently with the widespread of adoption TEVAR (79.8% to 53.7%; P < .001). In-hospital mortality after TEVAR decreased during the study period from 33.3% in 2005 to 4.9% in 2011 (P < .001), and an increase in mortality was observed for open repair from 13.9% to 19.2% (P < .001). Procedural mortality (TEVAR or open repair) decreased from 14.9% to 6.7% (P < .001), and mortality after any TTAI admission declined from 24.5% to 13.3% during the study period (P < .001). In addition to lower mortality, TEVAR was followed by fewer cardiac complications (4.1% vs 8.5%; P < .001), respiratory complications (47.5% vs 54.8%; P < .001), and shorter length of stay (18.4 vs 20.2 days; P = .012) compared with open repair. In adjusted mortality analyses, open repair proved to be associated with twice the mortality risk compared with TEVAR (odds ratio, 2.1; 95% confidence interval, 1.6-2.7), and nonoperative management was associated with more than a fourfold increase in mortality (odds ratio, 4.5; 95% confidence interval, 3.8-5.3).TEVAR is now the dominant surgical approach in TTAI, with substantial perioperative morbidity and mortality benefits over open aortic repair. Overall mortality after admission for TTAI has declined, which is most likely the result of the replacement of open repair by TEVAR as well as the broadened eligibility for operative repair.

Project description:ImportanceThoracic endovascular aortic repair (TEVAR) has been adopted rapidly for treating traumatic thoracic aortic injury (TAI). The long-term durability and efficacy remain unknown.ObjectiveTo determine the long-term outcomes of thoracic endovascular aortic repair and those of open repair (OR) for traumatic TAI.Design, setting, participantsThis nationwide cohort study used Taiwan's National Health Insurance Database to evaluate patients with traumatic TAI between January 1, 2004, and December 31, 2013. This single-payer National Health Insurance program covered more than 99.9% of the Taiwanese population. Those who received OR or TEVAR for TAI by propensity score matching were included. Data analysis was conducted in October 2017.ExposuresThoracic endovascular aortic repair vs open repair.Main outcomes and measuresIn-hospital outcomes, all-cause mortality, aorta reintervention, and stroke during follow-up.ResultsOf the 287 patients (mean [SD] age, 41.66 [17.98] years; 80.5% male) who received OR or TEVAR for TAI, propensity score matching yielded 100 patients each in the OR and TEVAR groups. After propensity score matching, in-hospital mortality risk was significantly lower in the TEVAR group (9 [9.0%]) than in the OR group (27 [27.0%]; TEVAR vs open repair: odds ratio, 0.27; 95% CI, 0.12-0.60). With a mean (SD) follow-up of 2.80 (2.63) years, the proportion of survivors was 71.9% at 1 year, 70.8% at 2 years, 68.2% at 3 years, and 65.1% at 5 years in the OR group vs 88.9% at 1 year, 88.9% at 2 years, 88.9% at 3 years, and 88.9% at 5 years in the TEVAR group (log-rank test, P < .001). The TEVAR group had only 2 events (2%) of late reintervention and 1 event (1%) of late cerebrovascular accident. The proportion of freedom from reintervention was 100% at 1 year, 100% at 2 years, 100% at 3 years, and 100% at 5 years in the OR group vs 97.4% at 1 year, 97.4% at 2 years, 97.4% at 3 years, and 97.4% at 5 years in the TEVAR group (log-rank test, P = .18).Conclusion and relevanceCompared with OR, TEVAR was associated with better long-term outcomes, mainly owing to lower mortality during the perioperative period. In addition, TEVAR was associated with a similar rate of survival and reintervention after hospital discharge.

Dataset Information

First Use of GORE TAG Thoracic Endograft with Active Control System in Traumatic Aortic Rupture.

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First Use of GORE TAG Thoracic Endograft with Active Control System in Traumatic Aortic Rupture.

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