Thoracic endovascular aortic repair with left subclavian artery reconstruction for blunt traumatic aortic injury in elderly patients

Introduction: Blunt thoracic aortic injury(BTAI) is rare in elderly patients. As the population ages and life expectancy increases, the frequency of this injury will increase, while the treatment and outcomes remain unclear.Methods: We retrospectively analyzed the collected data of patients >60 years old with BTAI to investigate the mechanism of trauma; time interval from injury to diagnosis; type and timing of surgical intervention; aortic arch pattern; choice of left subclavian artery reconstruction; endograft to treat BTAI; length of the endovascular procedure; endoleaks; complications including stroke, paraplegia, and renal failure; length of hospital stay(LOS)and intensive care unit stay(L.ICUS); and 30-day mortality.Results: Five elderly trauma patients were found to have BTAI. Four(80%) were males, the cohort mean age was68 years, the major mechanism of trauma was fall injury, and the associated injury was thoracic trauma. All patients were transferred to our hospital, and emergency computed tomography angiography showed BTAI in each patient. The average time interval from injury to diagnosis was 2.7 days. Two patients suddenly showed signs of instability in their vital signs and underwent immediate endovascular repair, while 3 patients underwent delayed endovascular repair. The injury site was located in the aortic isthmus just distal to the origin of the left subclavian artery; the aortic arch pattern was II(80.0%) in 4 cases and III in 1 case(20.0%). The choice of left subclavian artery reconstruction included chimney, double chimney, prefenestration, and chimney combined with in situ fenestration. Endografts to treat BTAI included the Ankura(Lifetech Scientific, Shenzhen, China) and the C-TAG(W.L. Gore & Associates, Flagstaff, AZ USA).The length of the endovascular procedure was 75.4 min;there were no endoleaks and no complications including stroke, paraplegia, or renal failure. The average LOS was25 days, and the average L.ICUS of 2 patients was 15 days, with no 30-day mortality.Conclusion: Elderly patients with fall injury should promptly exclude BTAI. Thoracic endovascular aortic repair(TEVAR) with a left subclavian artery reconstruction technique provided good results without procedure-related or neurological complications. Because of the low incidence of this type of injury, we are unable to provide any evidence to guide the treatment option for this life-threatening condition.