Adeli B, Gale J, Boyne N, McGahan T, Jackson M, Golledge J, Wu R, Buckenham T, Walker PJ.

TEVAR for traumatic aortic tear:

The Queensland experience.

Department of Vascular Surgery, Royal Brisbane & Women’s Hospital, University of Queensland, Department of Surgery and Centre for Clinical

Research, Brisbane, Australia.

� TEVAR has become an established treatment for traumatic aortic tears

(TAT) in many centres worldwide.

� No individual centre has a large experience with this condition.

The aim of this project was

to establish a Queensland

registry to document the registry to document the

clinical presentation,

procedural outcomes, and

follow-up results of TEVAR

for traumatic aortic injury.

� Funding was obtained from the CONROD-RACS Trauma

Fellowship to establish a state-wide registry with the

agreement and participation of the Vascular Surgery Units

throughout Queensland.

� Agreement was obtained from the New Zealand Registry to � Agreement was obtained from the New Zealand Registry to

allow us to mirror their data set.

� Inclusion criteria

� blunt trauma

� Exclusions

� deaths before intervention

� penetrating trauma (eg GSW, fish bone)

� Data was collected on a

retrospective basis on patients

already treated, and for new cases

the data is being collected on a

prospective basis.prospective basis.

� Data sheets and a SPSS database

were developed

� Patient demographics & risk factors

� Trauma aetiology

� Procedural details including adjunctive

procedures

� Outcomes

� Between 1996 and 2010 38 patients underwent

TEVAR for blunt TAT

mean age 43 years (range 17-78)� mean age 43 years (range 17-78)

� 80% (n=30) male

� 36 acute < 2 weeks

� 2 chronic 33 , 155 days

� MVA 19

� MBA 10

� Falls 4

Crush injury 3� Crush injury 3

� 2x work related

� 1x farm machinery

� Push bike 1

� Hang glider towed by car 1

� Descending TA 31� Descending TA 31

� Isthmus 4

� Arch 3

� All had significant associated injuries, predominantly

musculoskeletal and lung injury.

� 40% haemodynamically unstable at some stage

preoperatively; five patients had a systolic BP < preoperatively; five patients had a systolic BP <

100mmHg recorded pre-op in hospital.

� GCS was normal in 63%.

� ASA grade:

� ASA1 18%

� ASA2 9%

� ASA3 27%

� ASA4 46%

� Mean time between admission and surgery was 180 hr, 12 min (range 34

mins - 155 days); Median 11 hours, 19 mins

� For the acute (<2 week) patients 55 hours, 5 minutes

Patient ID

� 42% (n=15) had their TEVAR on the day of admission

� 34% (n=13) had their TEVAR on day two.

� One half had surgery outside normal hours.

� All procedures were performed under GA in a:

� Surgical Theatre 22

� Endovascular Suite 10

� Radiology Suite 6

� Femoral in 36 cases (95%)

� Iliac in two patients

� one direct CIA access

� one iliac conduit

Cook Zenith TX2

Cook TBE

22

3

Medtronic Talent 8

WL Gore TAG 3

� mean of 1.1 devices

� one prosthesis in 35 patients, 2 in 2 patients, 3 in 1 patient

� Intra-operative antihypertensive – 3 (9 %)

� Intra-operative heparin – 27 (73%)

� left SCA was

covered in 11

cases (29%)

� no other arch

vessels were

covered

� Two patients required ilio-femoral bypass grafts

for iliac vessel injury.

� No patient required conversion to open repair.

Mean procedure time was 2 hrs and 15 mins

(median 2:01; range 59 mins – 4:45)

Patient ID

� no procedures were abandoned

� no conversions to open repair

� 2 patients required further stent-grafting during their initial

admission for proximal and distal endoleaksadmission for proximal and distal endoleaks

� 1 perioperative death due to multisystem failure (2.6%)

� morbidity occurred in 23 patients (42%).

Graft related

� 2 endoleaks required further stenting – 1 endoleak persists

Neurological

� There was no instance of paraparesis / paraplegia

1 TIA ( blurred vision in right eye for few minutes)� 1 TIA ( blurred vision in right eye for few minutes)

Other

� 4 patients had groin / access site complications

� 1 infection and 3 fluid collection/haematoma

� 4 post implantation fever with no defined sepsis

� 4 prolonged ventilation and 2 others suffered pneumonia

� 1 patient suffered a PE and received an IVC filter

� 2 patients developed ARF (not requiring dialysis)

� Mean hospital stay was 49 days (median 27, range 3 - 328 days)

Patient ID

� FU range 10 days– 11 years

� 37 alive at last FU

� 17 lost to FU (refuse travel / treatment / reviews elsewhere)

� Mean FU for 20 patients still under surveillance = 20.4

monthsmonths

� 1 persisting endoleak – no further treatment so far

� 1 left CCA-SCA bypass for arm claudication and subclavian

steal symptoms @ 2years post TEVAR

� 1 left CCA-SCA bypass for arm claudication @ 5 weeks –

complicated by post-op Horner’s syndrome

� 1 persistent L thigh numbness from groin incision @ 28 weeks

� The early results of TEVAR for TAT in Queensland patients are

comparable to those reported by other centers around the world

� Low in hospital and 30 day mortality (2.6%)

� No paraplegia� No paraplegia

� Low stent graft related complication rate

� No Migration

� Significant hospital LOS

� Concerning loss to FU (45%)

� Long-term surveillance will enable us to determine the late outcome

and durability of this technique particularly in younger individuals.

� In the future, it is hoped to combine with the NZ Registry, and ultimately

to expand to a bi-national online registry including all states and

territories and encompassing all indications for TEVAR as already occurs

in NZ.

Thank youThank you