Outcomes of graft oversizing in small aortic lumens for the treatment of blunt thoracic aortic injuries.

Background: Blunt traumatic thoracic aortic injury (BTAI) is considered a life-threatening surgical emergency. Thoracic endovascular aortic repair (TEVAR) has significantly improved survival rates and reduced complications. The patients are typically young and present with normal aortic diameter. Often, there is a discrepancy in diameter between commercially available "off-the-shelf" thoracic aortic endografts and the diameter of the aorta.

Methods: We performed a retrospective study examining short-term outcomes of TEVAR oversizing for BTAI patients at our institution from 2004 to 2024. The primary outcome was procedural success, while secondary outcomes included endoleak, graft occlusion, and reintervention.

Results: A total of thirty-three cases involving BTAI were managed by TEVAR, with a mean age of 48.9±19.4 years. The injury severity score averaged 29.1±9.6 points. Most cases were grade 3 BTAI, accounting for 87.9%. The mean aortic diameter at the proximal landing zone was 24.4±3.6 mm, and the distal zone was 22.5±4.0 mm. Proximal stent oversizing was 31.9±4.1%, and the distal was 28.5±4.1%. All cases achieved procedural success. One case involved an early retrograde aortic dissection that required subsequent proximal extension, while another case presented an endoleak originating from the left subclavian branch, necessitating subclavian embolization and a bypass from the left carotid to the subclavian artery. No graft occlusions were reported.

Conclusions: The oversized TEVAR procedure may be performed under emergency conditions of BTAI, providing life-saving benefits with acceptable early outcomes.