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• W2783284757 abstract "Recent clinical practice guidelines on the management of descending thoracic aorta diseases of the European Society for Vascular Surgery (ESVS) recommend lifelong imaging surveillance after thoracic endovascular aortic repair (TEVAR) for different pathologies, including blunt traumatic aortic injury (BTAI).1Riambau V. Böckler D. Brunkwall J. Cao P. Chiesa R. Coppi G. et al.Editor's choice – management of descending thoracic aorta diseases: clinical practice guidelines of the ESVS.Eur J Vasc Endovasc Surg. 2017; 53: 4-52Abstract Full Text Full Text PDF PubMed Scopus (606) Google Scholar A specific surveillance program for BTAI patients treated with TEVAR has not yet been established. However, decreasing the surveillance frequency to 2 or to 5 years in the absence of any abnormalities on imaging in the first 12 to 36 months, has been suggested.1Riambau V. Böckler D. Brunkwall J. Cao P. Chiesa R. Coppi G. et al.Editor's choice – management of descending thoracic aorta diseases: clinical practice guidelines of the ESVS.Eur J Vasc Endovasc Surg. 2017; 53: 4-52Abstract Full Text Full Text PDF PubMed Scopus (606) Google Scholar Other clinical practice guidelines on TEVAR have also failed to report a differentiated surveillance program for BTAI.2Lee W.A. Matsumura J.S. Mitchell R.S. Farber M.A. Greenberg R.K. Azizzadeh A. et al.Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery.J Vasc Surg. 2011; 53: 187-192Abstract Full Text Full Text PDF PubMed Scopus (410) Google Scholar, 3Erbel R. Aboyans V. Boileau C. Bossone E. Bartolomeo R.D. Eggebrecht H. et al.ESC Committee for Practice Guidelines2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).Eur Heart J. 2014; 35: 2873-2926Crossref PubMed Scopus (2736) Google Scholar The surveillance of BTAI patients treated by TEVAR should consider two specific aspects of BTAI: the younger age of these patients and the traumatic nature of disease, in which progression does not develop once treated successfully. Despite the non-progressive nature of BTAI, graft induced dilation of the aorta and the potential stent graft related complications such as graft migration and collapse after bird beak configuration, still may raise concern for the long term. Forbes et al.4Forbes T.L. Harris J.R. Lawlor D.K. Derose G. Aortic dilatation after endovascular repair of blunt traumatic thoracic aortic injuries.J Vasc Surg. 2010; 52: 45-48Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar demonstrated progressive aortic dilation in stented segments up to 1 mm/y during the first 3 years after TEVAR. The RESCUE trial and other studies suggested that TEVAR for BTAI treatment is not associated with re-intervention.5Khoynezhad A. Azizzadeh A. Donayre C.E. Matsumoto A. Velazquez O. White R. Results of a multicenter, prospective trial of thoracic endovascular repair for blunt thoracic aortic injury (RESCUE trial).J Vasc Surg. 2013; 57: 899-905Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar, 6Mosquera V.X. Marini M. Lopez-Perez J.M. Muñiz-Garcia J. Herrera J.M. Cao I. et al.Role of conservative management in traumatic aortic injury: comparison of long-term results of conservative, surgical, and endovascular treatment.J Thorac Cardiovasc Surg. 2011; 142: 614-621Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 7Martin C. Thony F. Rodiere M. Bouzat P. Lavagne P. Durand M. et al.Long-term results following emergency stent graft repair for traumatic rupture of the aortic isthmus.Eur J Cardiothorac Surg. 2017; 51: 767-772PubMed Google Scholar No stent graft migration, kinking, twisting, fracture, or loss of stent graft integrity or patency was observed during follow-up to 14 years. In a meta-analysis, including 33 articles and 370 patients undergoing endovascular repair after a BTAI, the need for re-intervention because of displacement, insufficient sealing, collapse etc. was predominantly noted during the very early post-operative period (first month).8Tang G.L. Tehrani H.Y. Usman A. Katariya K. Otero C. Perez E. et al.Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: a modern meta-analysis.J Vasc Surg. 2008; 47: 671-675Abstract Full Text Full Text PDF PubMed Scopus (188) Google Scholar During follow-up, left arm ischaemia in three patients and late type 1a endoleak caused by aneurysmal degeneration of the aorta in one elderly patient were the only causes of late re-intervention.8Tang G.L. Tehrani H.Y. Usman A. Katariya K. Otero C. Perez E. et al.Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: a modern meta-analysis.J Vasc Surg. 2008; 47: 671-675Abstract Full Text Full Text PDF PubMed Scopus (188) Google Scholar The effect of surveillance frequency on outcomes was examined in another study, based on the timing of follow-up.9Spiliotopoulos K. Kokotsakis J. Argiriou M. Dedeilias P. Farsaris D. Diamantis T. et al.Endovascular repair for blunt thoracic aortic injury: 11-year outcomes and postoperative surveillance experience.J Thorac Cardiovasc Surg. 2014; 148: 2956-2961Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar No significant differences were found for survival, graft related complications, or need for re-intervention between patients adherent to timely follow-up (within ± 6 months of the scheduled annual visit) and patients with a delayed follow-up (> 6 months after scheduled annual visit).9Spiliotopoulos K. Kokotsakis J. Argiriou M. Dedeilias P. Farsaris D. Diamantis T. et al.Endovascular repair for blunt thoracic aortic injury: 11-year outcomes and postoperative surveillance experience.J Thorac Cardiovasc Surg. 2014; 148: 2956-2961Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Lack of compliance in younger patients is not uncommon. This may be because of employment demands and the fact that they feel better. A recent systematic review of the literature proved that every fourth patient was lost to follow-up after 1 year in TEVAR for BTAI.10Kidane B. Plourde M. Chadi S.A. Iansavitchene A. Meade M.O. Parry N.G. et al.The effect of loss to follow-up on treatment of blunt traumatic thoracic aortic injury.J Vasc Surg. 2015; 61: 1624-1634Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Additional concerns may arise regarding the cumulative radiation dose and contrast nephrotoxicity. Hence follow-up imaging with magnetic resonance angiography could improve the surveillance program attendance rate and reduce the risk of malignancy. It appears that potential complications after TEVAR for BTAI occur early post-operatively, with most of these being graft related, thus justifying early post-operative imaging. During late follow-up, rare graft related complications and aortic dilation may lead to re-interventions, thus justifying continued surveillance with increased follow-up intervals. The present authors suggest a simpler and safer surveillance protocol for patients after TEVAR for the treatment of BTAI (Fig. 1)." @default.
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• W2783284757 title "Surveillance After Endovascular Treatment for Blunt Thoracic Aortic Injury" @default.
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