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Endovascular Repair of Blunt Thoracic Aortic Trauma: Is Postimplant Hypertension an Incidental Finding?

Publication ,  Journal Article
Tigkiropoulos, K; Sigala, F; Tsilimigras, DI; Moris, D; Filis, K; Melas, N; Karamanos, D; Kontogiannis, C; Lazaridis, I; Saratzis, N
Published in: Annals of vascular surgery
July 2018

Blunt thoracic aortic injury (BTAI) is the second most common cause of death in trauma patients. Nowadays, thoracic endovascular aortic repair (TEVAR) has become the treatment of choice because of lower rates of mortality, paraplegia, and stroke. However, concerns have been raised whether graft implantation is related to the development of hypertension in the postoperative period. The aim of this study was to report short- and long-term outcomes of patients undergoing TEVAR for BTAIs at a tertiary hospital and to investigate postimplant hypertension.Between January 2005 and January 2016, 23 patients with blunt thoracic aortic trauma underwent TEVAR. Median age was 44 years (range, 18-73). Among them, 14 (60.9%) patients were diagnosed with aortic rupture, whereas 9 (39.1%) with pseudoaneurysm. Α single thoracic stent graft was deployed in 21 patients, and the rest 2 patients received 2 stent grafts.Complete exclusion of the injury was feasible in all subjects (100% primary success). The left subclavian artery (SCA) was intentionally covered in 6 patients (26%). Intraoperative complications included one nonfatal stroke managed conservatively and one external iliac artery rupture treated with iliofemoral bypass. One patient (4.3%) died on the first postoperative day in the intensive care unit (ICU) because of hemorrhagic shock. The overall 30-day mortality and morbidity were 4.3% and 8.7%, respectively. New-onset postimplantation arterial hypertension was observed in 8 (34.8%) previously nonhypertensive patients. Younger age (P = 0.027) and SCA coverage (P = 0.01) were identified as potential risk factors for the development of postimplant hypertension, whereas the presence of concomitant injuries (P = 0.3) and intraoperative complications (P = 0.1) were not. After a median follow-up of 100 months (range, 18-120), 6 of them still remain on antihypertensive therapy, whereas the other 2 did not require permanent treatment.TEVAR is a safe approach in the treatment of BTAI associated with low short- and long-term morbidity and mortality rates. Lower age and SCA coverage may contribute to the development of postimplant hypertension. Further larger cohort studies are warranted to elucidate the underlying mechanisms of postimplant hypertension.

Duke Scholars

Published In

Annals of vascular surgery

DOI

EISSN

1615-5947

ISSN

0890-5096

Publication Date

July 2018

Volume

50

Start / End Page

160 / 166.e1

Related Subject Headings

  • Young Adult
  • Wounds, Nonpenetrating
  • Vascular System Injuries
  • Treatment Outcome
  • Time Factors
  • Thoracic Injuries
  • Tertiary Care Centers
  • Subclavian Artery
  • Stents
  • Risk Factors
 

Citation

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Tigkiropoulos, K., Sigala, F., Tsilimigras, D. I., Moris, D., Filis, K., Melas, N., … Saratzis, N. (2018). Endovascular Repair of Blunt Thoracic Aortic Trauma: Is Postimplant Hypertension an Incidental Finding? Annals of Vascular Surgery, 50, 160-166.e1. https://doi.org/10.1016/j.avsg.2018.01.100
Tigkiropoulos, Konstantinos, Fragiska Sigala, Diamantis I. Tsilimigras, Demetrios Moris, Konstantinos Filis, Nikolaos Melas, Dimitrios Karamanos, Christos Kontogiannis, Ioannis Lazaridis, and Nikolaos Saratzis. “Endovascular Repair of Blunt Thoracic Aortic Trauma: Is Postimplant Hypertension an Incidental Finding?Annals of Vascular Surgery 50 (July 2018): 160-166.e1. https://doi.org/10.1016/j.avsg.2018.01.100.
Tigkiropoulos K, Sigala F, Tsilimigras DI, Moris D, Filis K, Melas N, et al. Endovascular Repair of Blunt Thoracic Aortic Trauma: Is Postimplant Hypertension an Incidental Finding? Annals of vascular surgery. 2018 Jul;50:160-166.e1.
Tigkiropoulos, Konstantinos, et al. “Endovascular Repair of Blunt Thoracic Aortic Trauma: Is Postimplant Hypertension an Incidental Finding?Annals of Vascular Surgery, vol. 50, July 2018, pp. 160-166.e1. Epmc, doi:10.1016/j.avsg.2018.01.100.
Tigkiropoulos K, Sigala F, Tsilimigras DI, Moris D, Filis K, Melas N, Karamanos D, Kontogiannis C, Lazaridis I, Saratzis N. Endovascular Repair of Blunt Thoracic Aortic Trauma: Is Postimplant Hypertension an Incidental Finding? Annals of vascular surgery. 2018 Jul;50:160-166.e1.
Journal cover image

Published In

Annals of vascular surgery

DOI

EISSN

1615-5947

ISSN

0890-5096

Publication Date

July 2018

Volume

50

Start / End Page

160 / 166.e1

Related Subject Headings

  • Young Adult
  • Wounds, Nonpenetrating
  • Vascular System Injuries
  • Treatment Outcome
  • Time Factors
  • Thoracic Injuries
  • Tertiary Care Centers
  • Subclavian Artery
  • Stents
  • Risk Factors