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Medline ® Abstract for Reference 61

of 'Surgical and endovascular repair of blunt thoracic aortic injury'

Comparison of thoracic aortic diameter changes after endograft placement in patients with traumatic and aneurysmal disease.
Alberta HB, Secor JL, Smits TC, Farber MA, Jordan WD, Azizzadeh A, Rovin JD, Matsumura JS
J Vasc Surg. 2014 May;59(5):1241-6. Epub 2014 Jan 11.
OBJECTIVE: The purpose of this study was to evaluate acute changes in aortic size before and after endograft placement for traumatic injury and aneurysmal disease. We hypothesize that there are inherent differences between trauma and aneurysm populations undergoing thoracic endovascular aortic repair (TEVAR) and that these factors may affect device choice and sizing for each group.
METHODS: This retrospective study evaluated the existing digital imaging of traumatic injury and aneurysmal patients enrolled in the 0802 and 0803 multi-site trials that received the GORE Conformable TAG thoracic device. Pre- and post-treatment imaging was available for 70 traumatic injury and 54 aneurysmal patients. Post-treatment imaging was defined as being complete within 30 days of treatment. A standardized protocol was used to complete measurements of the proximal and distal maximum neck diameters through the use of the orthogonal view before imaging and at 30-day imaging. The resultant changes in diameter for each group were analyzed by means of t-tests.
RESULTS: Mean increases in proximal (3.0 mm vs 2.0 mm; P<.05) and distal neck diameters (2.9 mm vs 0.7 mm; P<.01) after TEVAR are significantly greater in traumatic injury patients than in aneurysm patients between pretreatment and 30-day imaging. In both study populations, smaller pretreatment aortic neck diameters showed a larger change in neck diameter than did larger pretreatment aortic diameters. Aneurysm patients were oversized significantly more than were trauma patients at the proximal neck (9.1% vs 4.5%; P<.05). However, at the distal neck, the trauma patients were oversized more than were the aneurysm patients (17.5% vs 13.6%; P = .06). A strong correlation was found between the percentage of oversizing and change in the distal neck diameter after TEVAR in both patient groups.
CONCLUSIONS: The results suggest that there are differences between trauma and aneurysm populations. Careful device selection may contribute to the avoidance of complications related to both undersized and oversized devices. Short-term analysis shows that TEVAR can be successfully accomplished in both trauma and aneurysm groups over a wide sizing range. Further data regarding long-term device complications are needed to better characterize this relationship.
Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc. Electronic address: alberta@surgery.wisc.edu.