Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury: Impact of Arch Type on the Rate of Type 1 Endoleak

BACKGROUNDIn recent years, thoracic endovascular aortic repair (TEVAR) has emerged as the standard of care for management of blunt thoracic aortic injury (BTAI), resulting in reduced rates of in-hospital mortality.We identified factors, including arch type, that may impact endoleaks among these patients. METHODSThe Aortic Trauma Foundation registry was used to identify patients with BTAI managed with TEVAR from 2012 to 2023 for whom arch type was documented.Type 1 endoleak rates, graft specifications, lesion characteristics, demographics, and mechanism of injury were compared. RESULTSThe analysis included 405 patients.Patients with type II and III arches were more likely to have an endoleak compared with those with type I arches (4.3% vs 7.7% vs. 1.1%,P .019).Those with type 1 endoleak also had a higher maximum lesion diameter on average (31 mm vs 23 mm, P .034).Left subclavian artery coverage conferred a higher endoleak rate (5.1% vs 1.2%, P .019),particularly among those with type II or III arches (9.1%).Patients with endoleak did not have a higher mortality rate.Furthermore, there was no difference in rates of endoleak when comparing Society for Vascular Surgery grade, device dimensions, bovine anatomy, lesion length, sex, age, comorbidities, trauma center volume, Injury Severity Score, or mechanism.CONCLUSIONS As endovascular therapies continue to be the mainstay in the surgical management of BTAI, identification of anatomic features that increase the risk of technical failure is critical.Especially in cases of zone 2 TEVAR, arch angulation appears to impact endoleak rate and could influence device selection.