Single retrograde thoracic branch endoprosthesis versus standard endovascular repair with subclavian coverage for treatment of blunt thoracic aortic injuries.

Abstract

The Gore TAG thoracic branch endoprosthesis (TBE) allows zone 2 thoracic endovascular aortic repair (TEVAR), maintaining left subclavian artery (LSA) patency via side branch. We compared TBE for blunt thoracic aortic injuries (BTAIs) with TEVAR with subclavian artery coverage when seal into zone 2 was required. We retrospectively identified patients with repair for BTAI between 2011 and 2024. Patient characteristics, procedural details, and outcomes are reported and compared between cohorts. Between 2011 and 2024, 174 patients had endovascular repair of a BTAI at our institution. Of these, 65 had a repair involving coverage of the LSA. Seventeen repairs were with the TBE device, and 48 (31%) repairs were standard with TEVAR + LSA coverage. A total of nine patients of 48 had subclavian revascularization (19%). TBE cohort mean age was 55 years (±20 years) vs 45 years (±19 years) in the TEVAR + LSA coverage cohort. In the TBE cohort, 16 patients (94%) had complete percutaneous access (femoral and radial artery); one patient had percutaneous brachial access (injuries to the bilateral wrists precluding radial access) and open femoral exposure. In the TEVAR cohort, 21 patients (44%) had open femoral exposure (P = .29). Mean procedure time was 88.5 minutes (±44 minutes) in the TBE cohort, 102 minutes (±120 minutes) for standard TEVAR with LSA coverage, and 267.2 minutes (±120 minutes) for TEVAR with subclavian revascularization (P < .001). Technical success, device delivery with exclusion of injury, was 100% in both groups. There were no complications in the TBE cohort. Twelve patients in the TEVAR cohort experienced a complication, including wound infection (groin exposure), arm ischemia, stroke, endoleak, or retrograde dissection (0% vs 25%; P = .03). No aortic-related mortalities were observed. TBE side branch patency and BTAI exclusion was 100% at mean follow-up of 155 days. Similarly, BTAI was excluded in all TEVAR patients at a mean 364 days of follow-up. TBE offers a safe alternative to TEVAR with LSA coverage in BTAI when seal into zone 2 is required. A larger cohort is needed to confirm findings.