Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry

Aortic Trauma Foundation Study Group

doi:10.1016/j.jvs.2021.09.028

Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry

Aortic Trauma Foundation Study Group

Surgical Critical Care Initiative (SC2i)

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: Traumatic brain injury (TBI) and blunt thoracic aortic injury (BTAI) are the top two leading causes of death after blunt force trauma. Patients presenting with concomitant BTAI and TBI pose a specific challenge with respect to management strategy, because the optimal hemodynamic parameters are conflicting between the two pathologies. Early thoracic endovascular aortic repair (TEVAR) is often performed, even for minimal aortic injuries, to allow for the higher blood pressure parameters required for TBI management. However, the optimal timing of TEVAR for the treatment of BTAI in patients with concomitant TBI remains an active matter of controversy. Methods: The Aortic Trauma Foundation international prospective multicenter registry was used to identify all patients who had undergone TEVAR for BTAI in the setting of TBI from 2015 to 2020. The primary outcomes included delayed ischemic or hemorrhagic stroke, in-hospital mortality, and aortic-related mortality. The outcomes were examined among patients who had undergone TEVAR at emergent (<6 vs ≥6 hours) or urgent (<24 vs ≥24 hours) intervals. Results: A total of 100 patients (median age, 43 years; 79% men; median injury severity score, 41) with BTAI (Society for Vascular Surgery BTAI grade 1, 3%; grade 2, 10%; grade 3, 78%; grade 4, 9%) and concomitant TBI who had undergone TEVAR were identified. Emergent repair was performed for 51 patients (51%). Comparing emergent repair (<6 hours) to urgent repair (≥6 hours), no difference was found in delayed cerebral ischemic events (2.0% vs 4.1%; P = .614), in-hospital mortality (15.7% vs 22.4%; P = .389), or aortic-related mortality (2.0% vs 2.0%; P = .996) and no patient had experienced delayed hemorrhagic stroke. Likewise, repairs conducted in an urgent (<24 hours) setting showed no differences compared with those completed in an emergent (≥24 hours) setting regarding delayed ischemic stroke (2.6% vs 4.3%; P = .548), in-hospital mortality (18.2% vs 21.7%; P = .764), or aortic-related mortality (1.3% vs 4.3%; P = .654), and no patient had experienced delayed hemorrhagic stroke. Conclusions: In contrast to prior retrospective efforts, results from the Aortic Trauma Foundation international prospective multicenter registry have demonstrated that neither emergent nor urgent TEVAR for patients with concomitant BTAI and TBI was associated with delayed stroke, in-hospital mortality, or aortic-related mortality. In these patients, the timing of TEVAR did not have an effect on the outcomes. Therefore, the decision to intervene should be guided by individual patient factors rather than surgical timing.

Original language	English
Pages (from-to)	930-938
Number of pages	9
Journal	Journal of Vascular Surgery
Volume	75
Issue number	3
DOIs	https://doi.org/10.1016/j.jvs.2021.09.028
State	Published - Mar 2022

Keywords

Blunt thoracic aortic injury
Thoracic endovascular aortic repair
Traumatic brain injury
Vascular injury
Vascular trauma

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10.1016/j.jvs.2021.09.028

Cite this

@article{1291042269ba4331998e5ce3c43a20ff,

title = "Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry",

abstract = "Background: Traumatic brain injury (TBI) and blunt thoracic aortic injury (BTAI) are the top two leading causes of death after blunt force trauma. Patients presenting with concomitant BTAI and TBI pose a specific challenge with respect to management strategy, because the optimal hemodynamic parameters are conflicting between the two pathologies. Early thoracic endovascular aortic repair (TEVAR) is often performed, even for minimal aortic injuries, to allow for the higher blood pressure parameters required for TBI management. However, the optimal timing of TEVAR for the treatment of BTAI in patients with concomitant TBI remains an active matter of controversy. Methods: The Aortic Trauma Foundation international prospective multicenter registry was used to identify all patients who had undergone TEVAR for BTAI in the setting of TBI from 2015 to 2020. The primary outcomes included delayed ischemic or hemorrhagic stroke, in-hospital mortality, and aortic-related mortality. The outcomes were examined among patients who had undergone TEVAR at emergent (<6 vs ≥6 hours) or urgent (<24 vs ≥24 hours) intervals. Results: A total of 100 patients (median age, 43 years; 79% men; median injury severity score, 41) with BTAI (Society for Vascular Surgery BTAI grade 1, 3%; grade 2, 10%; grade 3, 78%; grade 4, 9%) and concomitant TBI who had undergone TEVAR were identified. Emergent repair was performed for 51 patients (51%). Comparing emergent repair (<6 hours) to urgent repair (≥6 hours), no difference was found in delayed cerebral ischemic events (2.0% vs 4.1%; P = .614), in-hospital mortality (15.7% vs 22.4%; P = .389), or aortic-related mortality (2.0% vs 2.0%; P = .996) and no patient had experienced delayed hemorrhagic stroke. Likewise, repairs conducted in an urgent (<24 hours) setting showed no differences compared with those completed in an emergent (≥24 hours) setting regarding delayed ischemic stroke (2.6% vs 4.3%; P = .548), in-hospital mortality (18.2% vs 21.7%; P = .764), or aortic-related mortality (1.3% vs 4.3%; P = .654), and no patient had experienced delayed hemorrhagic stroke. Conclusions: In contrast to prior retrospective efforts, results from the Aortic Trauma Foundation international prospective multicenter registry have demonstrated that neither emergent nor urgent TEVAR for patients with concomitant BTAI and TBI was associated with delayed stroke, in-hospital mortality, or aortic-related mortality. In these patients, the timing of TEVAR did not have an effect on the outcomes. Therefore, the decision to intervene should be guided by individual patient factors rather than surgical timing.",

keywords = "Blunt thoracic aortic injury, Thoracic endovascular aortic repair, Traumatic brain injury, Vascular injury, Vascular trauma",

author = "{Aortic Trauma Foundation Study Group} and Arbabi, {Cassra N.} and Joseph DuBose and Starnes, {Benjamin W.} and Naveed Saqib and Elina Quiroga and Charles Miller and Ali Azizzadeh and Kristofer Charlton-Ouw and Rana Afifi and Michelle McNutt and Zain Al-Rustum and Binod Shrestha and Ben Starnes and Rami Gilani and David Turay and Xian Luo-Owen and Tiffany Bee and Suzanne Moyer and Joe DuBose and William Shutze and William Dockery and Laura Petrey and Phelps, {Timothy N.} and Chuck Fox and Ernest Moore and Alexis Cralley and Pedro Teixeira and Emily Leede and Frank Buchanan and Emilio Ramos and Marielle Ngoue and Nicole Fox and Lisa Shea and Martin Zielinski and Fischmann, {Marianna Martini} and Kenji Inaba and Desmond Khor and Gregory Magee and Malachi Sheahan and Marie Unruh and Neil Parry and Luc Dubois and John Berne and Ivan Puente and Gomez, {Mario F.} and Mederos, {Dalier R.} and John Bini and Karen Herzing and Claire Hardman and Jonathan Morrison",

note = "Funding Information: The Aortic Trauma Foundation collaborators (primary investigators; if not included in the “Authors Contributions” section, the contributions included data collection): UTHealth: Naveed Saqib, MD, Kristofer Charlton-Ouw, MD, Rana Afifi, MD, Michelle McNutt, MD, Zain Al-Rustum, MD, Binod Shrestha, MD, and Edmundo Dipasupil, MD; University of Washington: Elina Quiroga, MD, and Ben Starnes, MD; Baylor College of Medicine/Ben Taub: Rami Gilani, MD; Loma Linda University: David Turay, MD, and Xian Luo-Owen, MD; University of Tennessee Health Science Center (Memphis): Tiffany Bee, MD, Suzanne Moyer, DNP, APRN, AG-ACNP; R Adams Cowley Shock Trauma Center: Joe DuBose, MD; Baylor Scott & White Health: William Shutze, MD, William Dockery, MD, Laura Petrey, MD, and Timothy N. Phelps, MD; Denver Health and Hospital Authority: Chuck Fox, MD, Ernest Moore, MD, and Alexis Cralley, MD; Dell Seton Medical Center: Pedro Teixeira, MD, Emily Leede, MD, Frank Buchanan, MD, Emilio Ramos, MD, and Marielle Ngoue, MD; Cooper University Hospital: Nicole Fox, MD, and Lisa Shea, MS; Mayo Clinic Rochester: Martin Zielinski, MD, and Marianna Martini Fischmann, MD; LAC+USC Medical Center: Kenji Inaba, MD, Desmond Khor, MD, and Gregory Magee, MD; LSU Health Sciences Center/University Medical Center, New Orleans: Malachi Sheahan, MD, and Marie Unruh, MD; London Health Sciences Centre: Neil Parry, MD, and Luc Dubois, MD; Broward Health: John Berne, MD, Ivan Puente, MD, Mario F. Gomez, DO, and Dalier R. Mederos, MD; Miami Valley Hospital/Premier Health: John Bini, MD, Karen Herzing RN, MSN, and Claire Hardman, RN, BSN; UMass Memorial Health Care: Andres Schanzer, MD, Francesco Aiello, MD, Edward Arous, MD, Elias Arous, MD, Douglas Jones, MD, Dejah Judelson, MD, Louis Messina, MD, Tammy Nguyen, MD, Jessica Simons, MD, and Robert Steppacher, MD; St Michael's Hospital: Joao Rezende-Neto, MD; Via Christi Regional Medical Center: James Haan, MD, and Kelly Lightwine, MPH; Medical Center of the Rockies: Julie Dunn, MD, and Brittany Smoot; {\"O}rebro University Hospital: Tal Horer, MD, and David McGreevy, MD; Hospital Clinic de Barcelona: Vincent Riambau, MD, Gaspar Mestres, MD, and Xavier Yugueros, MD; University of Alabama at Birmingham: Marc Passman, MD, Adam W. Beck, MD, Mark Patterson, MD, Ben Pearce, MD, Emily Spangler, MD, Graeme McFarland, MD, and Danielle Sutzko, MD; St. Louis University: Matt Smeds, MD, Emad Zakhary, MD, Michael Williams, MD, and Catherine Wittgen, MD; University of Missouri: Todd Vogel, MD; Massachusetts General Hospital: Matt Eagleton, MD; Cedars Sinai Medical Center: Ali Azizzadeh, MD, Bruce Gewertz, MD, Galinos Barmparas, MD, and Cassra Arbabi, MD; University of Maryland: Joseph DuBose, MD, Rishi Kundi, MD, and Jonathan Morrison, MD, PhD; Medical College of Wisconsin: Peter Rossi, MD; Sant'Orsola Hospital: Davide Pacini, MD, Luca Botta, MD, and Ciro Amodio, MD; Grande Ospedale Metropolitano Niguarda: Pierantonio Rimoldi, MD, Ilenia D'Alessio, MD, and Nicola Monzio Compagnoni, MD; University of Coloraro/UCHealth: Muhammad Aftab, MD, Mohammed Al-Musawi, MD, T. Brett Reece, MD, Jay D. Pal, MD, Donald Jacobs, MD, Rafael D. Malgor, MD, and Devin Zarkowsky, MD; Emory University at Grady Memorial: Ravi Rajani, MD, Jaime Benarroch-Gampel, MD, and Christopher R. Ramos, MD; Beth Israel Deaconess Medical Center: Marc Schermerhorn, MD, Mark Wyers, MD, Allen Hamdan, MD, Lars Stangenberg, MD, and Andy Lee, MD; University of Texas HSC San Antonio: Mark Davies, MD, Lalithapriya (Priya) Jayakumar, MD, Matthew J. Sideman, MD, Christopher Mitromaras, MD, Dimitrios Miserlis, MD, and Reshma Brahmbhatt, MD; Albany Medical College: Ralph Darling, MD, Xzabia Caliste, MD, Benjamin B. Chang, MD, Jeffrey C. Hnath, MD, Paul B. Kreienberg, MD, Alexander Kryszuk, MD, Adriana Laser, MD, Sean P. Roddy, MD, Stephanie Saltzberg, MD, Melissa Shah, MD, Courtney Warner, MD, and Chin-Chin Yeh, MD; Kirov Military Medical Academy: Viktor Reva, MD, Viktor Zhigalo, MD, and Alexander V. Krasikov, MD; Fondazione IRCCS Policlinico, Milan, Italy: Santi Trimarchi, MD, Maurizio Domanin, MD, and Ilenia D'Alessio, MD; University of Chicago: Trissa Babrowski, MD, Ross Milner, MD, Luka Pocivavsek, MD, and Christopher Skelly, MD; and Maine Medical Center: Kimberly Malka, MD, and Brian Nolan, MD. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. Publisher Copyright: {\textcopyright} 2021 Society for Vascular Surgery",

year = "2022",

month = mar,

doi = "10.1016/j.jvs.2021.09.028",

language = "English",

volume = "75",

pages = "930--938",

journal = "Journal of Vascular Surgery",

issn = "0741-5214",

number = "3",

}

TY - JOUR

T1 - Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry

AU - Aortic Trauma Foundation Study Group

AU - Arbabi, Cassra N.

AU - DuBose, Joseph

AU - Starnes, Benjamin W.

AU - Saqib, Naveed

AU - Quiroga, Elina

AU - Miller, Charles

AU - Azizzadeh, Ali

AU - Charlton-Ouw, Kristofer

AU - Afifi, Rana

AU - McNutt, Michelle

AU - Al-Rustum, Zain

AU - Shrestha, Binod

AU - Starnes, Ben

AU - Gilani, Rami

AU - Turay, David

AU - Luo-Owen, Xian

AU - Bee, Tiffany

AU - Moyer, Suzanne

AU - DuBose, Joe

AU - Shutze, William

AU - Dockery, William

AU - Petrey, Laura

AU - Phelps, Timothy N.

AU - Fox, Chuck

AU - Moore, Ernest

AU - Cralley, Alexis

AU - Teixeira, Pedro

AU - Leede, Emily

AU - Buchanan, Frank

AU - Ramos, Emilio

AU - Ngoue, Marielle

AU - Fox, Nicole

AU - Shea, Lisa

AU - Zielinski, Martin

AU - Fischmann, Marianna Martini

AU - Inaba, Kenji

AU - Khor, Desmond

AU - Magee, Gregory

AU - Sheahan, Malachi

AU - Unruh, Marie

AU - Parry, Neil

AU - Dubois, Luc

AU - Berne, John

AU - Puente, Ivan

AU - Gomez, Mario F.

AU - Mederos, Dalier R.

AU - Bini, John

AU - Herzing, Karen

AU - Hardman, Claire

AU - Morrison, Jonathan

N1 - Funding Information: The Aortic Trauma Foundation collaborators (primary investigators; if not included in the “Authors Contributions” section, the contributions included data collection): UTHealth: Naveed Saqib, MD, Kristofer Charlton-Ouw, MD, Rana Afifi, MD, Michelle McNutt, MD, Zain Al-Rustum, MD, Binod Shrestha, MD, and Edmundo Dipasupil, MD; University of Washington: Elina Quiroga, MD, and Ben Starnes, MD; Baylor College of Medicine/Ben Taub: Rami Gilani, MD; Loma Linda University: David Turay, MD, and Xian Luo-Owen, MD; University of Tennessee Health Science Center (Memphis): Tiffany Bee, MD, Suzanne Moyer, DNP, APRN, AG-ACNP; R Adams Cowley Shock Trauma Center: Joe DuBose, MD; Baylor Scott & White Health: William Shutze, MD, William Dockery, MD, Laura Petrey, MD, and Timothy N. Phelps, MD; Denver Health and Hospital Authority: Chuck Fox, MD, Ernest Moore, MD, and Alexis Cralley, MD; Dell Seton Medical Center: Pedro Teixeira, MD, Emily Leede, MD, Frank Buchanan, MD, Emilio Ramos, MD, and Marielle Ngoue, MD; Cooper University Hospital: Nicole Fox, MD, and Lisa Shea, MS; Mayo Clinic Rochester: Martin Zielinski, MD, and Marianna Martini Fischmann, MD; LAC+USC Medical Center: Kenji Inaba, MD, Desmond Khor, MD, and Gregory Magee, MD; LSU Health Sciences Center/University Medical Center, New Orleans: Malachi Sheahan, MD, and Marie Unruh, MD; London Health Sciences Centre: Neil Parry, MD, and Luc Dubois, MD; Broward Health: John Berne, MD, Ivan Puente, MD, Mario F. Gomez, DO, and Dalier R. Mederos, MD; Miami Valley Hospital/Premier Health: John Bini, MD, Karen Herzing RN, MSN, and Claire Hardman, RN, BSN; UMass Memorial Health Care: Andres Schanzer, MD, Francesco Aiello, MD, Edward Arous, MD, Elias Arous, MD, Douglas Jones, MD, Dejah Judelson, MD, Louis Messina, MD, Tammy Nguyen, MD, Jessica Simons, MD, and Robert Steppacher, MD; St Michael's Hospital: Joao Rezende-Neto, MD; Via Christi Regional Medical Center: James Haan, MD, and Kelly Lightwine, MPH; Medical Center of the Rockies: Julie Dunn, MD, and Brittany Smoot; Örebro University Hospital: Tal Horer, MD, and David McGreevy, MD; Hospital Clinic de Barcelona: Vincent Riambau, MD, Gaspar Mestres, MD, and Xavier Yugueros, MD; University of Alabama at Birmingham: Marc Passman, MD, Adam W. Beck, MD, Mark Patterson, MD, Ben Pearce, MD, Emily Spangler, MD, Graeme McFarland, MD, and Danielle Sutzko, MD; St. Louis University: Matt Smeds, MD, Emad Zakhary, MD, Michael Williams, MD, and Catherine Wittgen, MD; University of Missouri: Todd Vogel, MD; Massachusetts General Hospital: Matt Eagleton, MD; Cedars Sinai Medical Center: Ali Azizzadeh, MD, Bruce Gewertz, MD, Galinos Barmparas, MD, and Cassra Arbabi, MD; University of Maryland: Joseph DuBose, MD, Rishi Kundi, MD, and Jonathan Morrison, MD, PhD; Medical College of Wisconsin: Peter Rossi, MD; Sant'Orsola Hospital: Davide Pacini, MD, Luca Botta, MD, and Ciro Amodio, MD; Grande Ospedale Metropolitano Niguarda: Pierantonio Rimoldi, MD, Ilenia D'Alessio, MD, and Nicola Monzio Compagnoni, MD; University of Coloraro/UCHealth: Muhammad Aftab, MD, Mohammed Al-Musawi, MD, T. Brett Reece, MD, Jay D. Pal, MD, Donald Jacobs, MD, Rafael D. Malgor, MD, and Devin Zarkowsky, MD; Emory University at Grady Memorial: Ravi Rajani, MD, Jaime Benarroch-Gampel, MD, and Christopher R. Ramos, MD; Beth Israel Deaconess Medical Center: Marc Schermerhorn, MD, Mark Wyers, MD, Allen Hamdan, MD, Lars Stangenberg, MD, and Andy Lee, MD; University of Texas HSC San Antonio: Mark Davies, MD, Lalithapriya (Priya) Jayakumar, MD, Matthew J. Sideman, MD, Christopher Mitromaras, MD, Dimitrios Miserlis, MD, and Reshma Brahmbhatt, MD; Albany Medical College: Ralph Darling, MD, Xzabia Caliste, MD, Benjamin B. Chang, MD, Jeffrey C. Hnath, MD, Paul B. Kreienberg, MD, Alexander Kryszuk, MD, Adriana Laser, MD, Sean P. Roddy, MD, Stephanie Saltzberg, MD, Melissa Shah, MD, Courtney Warner, MD, and Chin-Chin Yeh, MD; Kirov Military Medical Academy: Viktor Reva, MD, Viktor Zhigalo, MD, and Alexander V. Krasikov, MD; Fondazione IRCCS Policlinico, Milan, Italy: Santi Trimarchi, MD, Maurizio Domanin, MD, and Ilenia D'Alessio, MD; University of Chicago: Trissa Babrowski, MD, Ross Milner, MD, Luka Pocivavsek, MD, and Christopher Skelly, MD; and Maine Medical Center: Kimberly Malka, MD, and Brian Nolan, MD. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. Publisher Copyright: © 2021 Society for Vascular Surgery

PY - 2022/3

Y1 - 2022/3

N2 - Background: Traumatic brain injury (TBI) and blunt thoracic aortic injury (BTAI) are the top two leading causes of death after blunt force trauma. Patients presenting with concomitant BTAI and TBI pose a specific challenge with respect to management strategy, because the optimal hemodynamic parameters are conflicting between the two pathologies. Early thoracic endovascular aortic repair (TEVAR) is often performed, even for minimal aortic injuries, to allow for the higher blood pressure parameters required for TBI management. However, the optimal timing of TEVAR for the treatment of BTAI in patients with concomitant TBI remains an active matter of controversy. Methods: The Aortic Trauma Foundation international prospective multicenter registry was used to identify all patients who had undergone TEVAR for BTAI in the setting of TBI from 2015 to 2020. The primary outcomes included delayed ischemic or hemorrhagic stroke, in-hospital mortality, and aortic-related mortality. The outcomes were examined among patients who had undergone TEVAR at emergent (<6 vs ≥6 hours) or urgent (<24 vs ≥24 hours) intervals. Results: A total of 100 patients (median age, 43 years; 79% men; median injury severity score, 41) with BTAI (Society for Vascular Surgery BTAI grade 1, 3%; grade 2, 10%; grade 3, 78%; grade 4, 9%) and concomitant TBI who had undergone TEVAR were identified. Emergent repair was performed for 51 patients (51%). Comparing emergent repair (<6 hours) to urgent repair (≥6 hours), no difference was found in delayed cerebral ischemic events (2.0% vs 4.1%; P = .614), in-hospital mortality (15.7% vs 22.4%; P = .389), or aortic-related mortality (2.0% vs 2.0%; P = .996) and no patient had experienced delayed hemorrhagic stroke. Likewise, repairs conducted in an urgent (<24 hours) setting showed no differences compared with those completed in an emergent (≥24 hours) setting regarding delayed ischemic stroke (2.6% vs 4.3%; P = .548), in-hospital mortality (18.2% vs 21.7%; P = .764), or aortic-related mortality (1.3% vs 4.3%; P = .654), and no patient had experienced delayed hemorrhagic stroke. Conclusions: In contrast to prior retrospective efforts, results from the Aortic Trauma Foundation international prospective multicenter registry have demonstrated that neither emergent nor urgent TEVAR for patients with concomitant BTAI and TBI was associated with delayed stroke, in-hospital mortality, or aortic-related mortality. In these patients, the timing of TEVAR did not have an effect on the outcomes. Therefore, the decision to intervene should be guided by individual patient factors rather than surgical timing.

AB - Background: Traumatic brain injury (TBI) and blunt thoracic aortic injury (BTAI) are the top two leading causes of death after blunt force trauma. Patients presenting with concomitant BTAI and TBI pose a specific challenge with respect to management strategy, because the optimal hemodynamic parameters are conflicting between the two pathologies. Early thoracic endovascular aortic repair (TEVAR) is often performed, even for minimal aortic injuries, to allow for the higher blood pressure parameters required for TBI management. However, the optimal timing of TEVAR for the treatment of BTAI in patients with concomitant TBI remains an active matter of controversy. Methods: The Aortic Trauma Foundation international prospective multicenter registry was used to identify all patients who had undergone TEVAR for BTAI in the setting of TBI from 2015 to 2020. The primary outcomes included delayed ischemic or hemorrhagic stroke, in-hospital mortality, and aortic-related mortality. The outcomes were examined among patients who had undergone TEVAR at emergent (<6 vs ≥6 hours) or urgent (<24 vs ≥24 hours) intervals. Results: A total of 100 patients (median age, 43 years; 79% men; median injury severity score, 41) with BTAI (Society for Vascular Surgery BTAI grade 1, 3%; grade 2, 10%; grade 3, 78%; grade 4, 9%) and concomitant TBI who had undergone TEVAR were identified. Emergent repair was performed for 51 patients (51%). Comparing emergent repair (<6 hours) to urgent repair (≥6 hours), no difference was found in delayed cerebral ischemic events (2.0% vs 4.1%; P = .614), in-hospital mortality (15.7% vs 22.4%; P = .389), or aortic-related mortality (2.0% vs 2.0%; P = .996) and no patient had experienced delayed hemorrhagic stroke. Likewise, repairs conducted in an urgent (<24 hours) setting showed no differences compared with those completed in an emergent (≥24 hours) setting regarding delayed ischemic stroke (2.6% vs 4.3%; P = .548), in-hospital mortality (18.2% vs 21.7%; P = .764), or aortic-related mortality (1.3% vs 4.3%; P = .654), and no patient had experienced delayed hemorrhagic stroke. Conclusions: In contrast to prior retrospective efforts, results from the Aortic Trauma Foundation international prospective multicenter registry have demonstrated that neither emergent nor urgent TEVAR for patients with concomitant BTAI and TBI was associated with delayed stroke, in-hospital mortality, or aortic-related mortality. In these patients, the timing of TEVAR did not have an effect on the outcomes. Therefore, the decision to intervene should be guided by individual patient factors rather than surgical timing.

KW - Blunt thoracic aortic injury

KW - Thoracic endovascular aortic repair

KW - Traumatic brain injury

KW - Vascular injury

KW - Vascular trauma

UR - http://www.scopus.com/inward/record.url?scp=85118788027&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2021.09.028

DO - 10.1016/j.jvs.2021.09.028

M3 - Article

C2 - 34606963

AN - SCOPUS:85118788027

SN - 0741-5214

VL - 75

SP - 930

EP - 938

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

IS - 3

ER -

Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry

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