The Impact of Urgency of Repair on Outcomes Following Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury

Current societal recommendations regarding the timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) vary. Prior studies have shown that elective repair was associated with lower mortality following TEVAR for BTAI. However, these studies lacked data such as Society for Vascular Surgery (SVS) aortic injury grades and TEVAR-related postoperative outcomes. Therefore, we used the Vascular Quality Initiative (VQI) registry, which includes relevant anatomic and outcome data, to examine the outcomes following urgent/emergent (≤24 hrs) versus elective TEVAR for BTAI. Patients undergoing TEVAR for BTAI between 2013-2022 were included, excluding those with SVS grade 4 aortic injuries. We included covariates such as age, sex, race, transfer status, body mass index, preoperative hemoglobin, comorbities, medication use, SVS aortic injury grade, coexisting injuries, Glasgow coma score, and prior aortic surgery in a regression model to compute propensity scores for assignment to urgent/emergent or elective TEVAR. Perioperative outcomes and 5-year mortality were evaluated using inverse probability-weighted logistic regression and Cox regression, also adjusting for left subclavian artery revascularization/occlusion, and annual center and physician volumes. Of 1016 patients, 102 (10%) underwent elective TEVAR. Patients who underwent elective repair were more likely to undergo revascularization of the left subclavian artery (31% vs. 7.5%;p.9).Compared with urgent/emergent TEVAR, elective repair was associated with lower postoperative stroke (1.0% vs 2.1%; aOR: 0.12 [0.02-0.94];p=.044), even after adjusting for intraoperative heparin use (aOR: 0.12 [0.02-0.92];p=.042). Elective TEVAR was also associated with lower odds of failure of extubation immediately after surgery (39% vs 65%; aOR: 0.18 [0.09-0.35];p