Effect of Intravascular Ultrasound on Clinical Outcomes after TEVAR for Blunt Thoracic Aortic Injury.

Abstract

OBJECTIVE\nTEVAR for blunt traumatic aortic injuries (BTAI) can be complicated by inaccurate aortic measurements at the time of initial CTA secondary to hypovolemic shock. IVUS use has been proposed for more accurate aortic sizing, with prior data demonstrating larger aortic sizes as measured by IVUS, potentially altering the vast majority of chosen endograft sizes. At present, no studies have examined whether IVUS affects clinical outcomes. The purpose of this study was to examine the impact of IVUS on clinical outcomes in BTAI TEVAR.\n\n\nMETHODS\nA retrospective cohort study was performed of patients undergoing TEVAR for BTAI in the VQI registry. Cohorts were defined by IVUS utilization; primary outcomes were mortality and reintervention at 1-year.\n\n\nRESULTS\n919 patients undergoing TEVAR for BTAI were included in the analysis. IVUS patients presented with higher Injury Severity Scores (36.2 vs. 42, p = 0.0004) largely due to more extremity and external trauma. IVUS was more often used in patients with grade III injuries (49.1% vs. 56.9%, p = 0.02), and less often in ruptures (21.1% vs. 12.4%, p = 0.001). A trend toward delay in TEVAR was seen in cases where IVUS was used (1.8 vs. 3.5 days, p = 0.38), with additional trends toward reduced intraoperative resuscitation and blood loss. Hemodynamic status of patients and differences in aortic or endograft sizes could not be assessed with the available data. IVUS use was not associated with any difference in survival or reintervention rates in-hospital or at 1-year (KM Survival Estimates: 0.91 No-IVUS vs. 0.92 IVUS, p = 0.46); 15 aortic-related reinterventions occurred across the entire patient cohort in all-available follow-up with comparable rates of Type I endoleaks (1 No-IVUS vs. 2 IVUS), and no recorded instances of sizing-related complications such as device rupture, migration, or dissection.\n\n\nCONCLUSIONS\nIVUS utilization in TEVAR for BTAI is associated with clinical scenarios where patients are more stable and interventions to address BTAI can be delayed. Despite this, overall clinical outcomes were similar between cases where IVUS was utilized and where it was not.