This document summarizes the establishment of a registry in Queensland, Australia to document outcomes of TEVAR (thoracic endovascular aortic repair) for traumatic aortic tears. Between 1996-2010, 38 patients underwent TEVAR for blunt traumatic aortic tears with a mean age of 43. The majority were male victims of motor vehicle or motorbike accidents. Outcomes included a low 30-day mortality rate of 2.6%, no instances of paralysis, and a low stent graft complication rate. However, follow-up was concerning with 45% lost to follow-up. The registry aims to evaluate long-term outcomes and durability of TEVAR for traumatic aortic injuries.

1. TEVAR for traumatic aortic tear:
The Queensland experience.
Adeli B, Gale J, Boyne N, McGahan T, Jackson M,
Golledge J, Wu R, Buckenham T, Walker PJ.
Department of Vascular Surgery, Royal Brisbane & Women’s Hospital,
University of Queensland, Department of Surgery and Centre for Clinical
Research, Brisbane, Australia.

2. TEVAR has become an established treatment for traumatic aortic tears
(TAT) in many centres worldwide.
No individual centre has a large experience with this condition.

3. The aim of this project was
to establish a Queensland
registry to document the
clinical presentation,
procedural outcomes, and
follow-up results of TEVAR
for traumatic aortic injury.

4. Funding was obtained from the CONROD-RACS Trauma
Fellowship to establish a state-wide registry with the
agreement and participation of the Vascular Surgery Units
throughout Queensland.
Agreement was obtained from the New Zealand Registry to
allow us to mirror their data set.
Inclusion criteria
blunt trauma
Exclusions
deaths before intervention
penetrating trauma (eg GSW, fish bone)

5. Data was collected on a
retrospective basis on patients
already treated, and for new cases
the data is being collected on a
prospective basis.
Data sheets and a SPSS database
were developed
Patient demographics & risk factors
Trauma aetiology
Procedural details including adjunctive
procedures
Outcomes

6. Between 1996 and 2010 38 patients underwent
TEVAR for blunt TAT
mean age 43 years (range 17-78)
80% (n=30) male
36 acute < 2 weeks
2 chronic 33 , 155 days

7. MVA 19
MBA 10
Falls 4
Crush injury 3
2x work related
1x farm machinery
Push bike 1
Hang glider towed by car 1

8. Descending TA 31
Isthmus 4
Arch 3

9. All had significant associated injuries, predominantly
musculoskeletal and lung injury.
40% haemodynamically unstable at some stage
preoperatively; five patients had a systolic BP <
100mmHg recorded pre-op in hospital.
GCS was normal in 63%.
ASA grade:
ASA1 18%
ASA2 9%
ASA3 27%
ASA4 46%

10. Patient ID
Mean time between admission and surgery was 180 hr, 12 min (range 34
mins - 155 days); Median 11 hours, 19 mins
For the acute (<2 week) patients 55 hours, 5 minutes

11. 42% (n=15) had their TEVAR on the day of admission
34% (n=13) had their TEVAR on day two.
One half had surgery outside normal hours.

12. All procedures were performed under GA in a:
Surgical Theatre 22
Endovascular Suite 10
Radiology Suite 6

13. Femoral in 36 cases (95%)
Iliac in two patients
one direct CIA access
one iliac conduit

14. Cook Zenith TX2 22
Cook TBE 3
Medtronic Talent 8
WL Gore TAG 3
mean of 1.1 devices
one prosthesis in 35 patients, 2 in 2 patients, 3 in 1 patient

15. Intra-operative antihypertensive – 3 (9 %)
Intra-operative heparin – 27 (73%)

16. left SCA was
covered in 11
cases (29%)
no other arch
vessels were
covered

17. Two patients required ilio-femoral bypass grafts
for iliac vessel injury.
No patient required conversion to open repair.

18. Mean procedure time was 2 hrs and 15 mins
(median 2:01; range 59 mins – 4:45)
Patient ID

19. no procedures were abandoned
no conversions to open repair
2 patients required further stent-grafting during their initial
admission for proximal and distal endoleaks
1 perioperative death due to multisystem failure (2.6%)
morbidity occurred in 23 patients (42%).

20. Graft related
2 endoleaks required further stenting – 1 endoleak persists
Neurological
There was no instance of paraparesis / paraplegia
1 TIA ( blurred vision in right eye for few minutes)
Other
4 patients had groin / access site complications
1 infection and 3 fluid collection/haematoma
4 post implantation fever with no defined sepsis
4 prolonged ventilation and 2 others suffered pneumonia
1 patient suffered a PE and received an IVC filter
2 patients developed ARF (not requiring dialysis)

21. Mean hospital stay was 49 days (median 27, range 3 - 328 days)
Patient ID

22. FU range 10 days– 11 years
37 alive at last FU
17 lost to FU (refuse travel / treatment / reviews elsewhere)
Mean FU for 20 patients still under surveillance = 20.4
months
1 persisting endoleak – no further treatment so far
1 left CCA-SCA bypass for arm claudication and subclavian
steal symptoms @ 2years post TEVAR
1 left CCA-SCA bypass for arm claudication @ 5 weeks –
complicated by post-op Horner’s syndrome
1 persistent L thigh numbness from groin incision @ 28 weeks

23. The early results of TEVAR for TAT in Queensland patients are
comparable to those reported by other centers around the world
Low in hospital and 30 day mortality (2.6%)
No paraplegia
Low stent graft related complication rate
No Migration
Significant hospital LOS
Concerning loss to FU (45%)

24. Long-term surveillance will enable us to determine the late outcome
and durability of this technique particularly in younger individuals.
In the future, it is hoped to combine with the NZ Registry, and ultimately
to expand to a bi-national online registry including all states and
territories and encompassing all indications for TEVAR as already occurs
in NZ.

25. Thank you