RS01 - Hospital Setting of Endovascular Repair Influences Procedural Outcomes in Blunt Traumatic Aortic Injury

Objectives: Blunt thoracic aortic injury (BTAI) is most frequently treated with thoracic endovascular aneurysm repair (TEVAR) requiring advanced endovascular imaging capabilities. These are broadly used for elective aortic procedures but may not be consistently available to treat BTAI. Procedure characteristics and outcomes may vary when TEVAR is performed in the setting of a standard operating room with a portable C-Arm versus in a hybrid operating room or interventional radiology suite with a fixed imaging system. This study aimed to compare clinical characteristics and outcomes of TEVAR for BTAI across these settings. We hypothesized that cases performed with a C-arm would lead to higher rates of complication.

Methods: The PROspective Observational Vascular Injury Treatment (PROOVIT) registry captures trauma-specific outcomes related to vascular injury across 14 U.S. trauma centers in the U.S. The registry was queried for BTAI undergoing TEVAR from 2012-2021. Cases were categorized as having been performed in a standard OR with portable C-Arm imaging (C-Arm), or in a fixed imaging suite (hybrid room (Hybrid) or interventional radiology (IR)). Procedural characteristics and complications (arterial access, reintervention, stroke) were collected and compared using univariate and multivariate analyses.

Results: PROOVIT contained 199 TEVAR for BTAI: 82 C-Arm, 75 Hybrid, 42 IR. There was no clear temporal trend in TEVAR setting (Fig 1). Demographics and mechanism were similar between groups; Hybrid room procedures had higher median ISS (38, IQR 14) than C-Arm (33, 15) and IR (29, 25; P=0.02) and a higher proportion of cases with AIS head score >3 (44% vs 28% C-Arm vs 24% IR, P=0.06) (Table I). Hybrid cases were most often delayed >6h from arrival (78% vs 48% vs 41%, P< 0.001) but C-Arm cases most frequently lasted over 3 hours (34% vs 12% Hybrid vs 15% IR, P=0.002). Procedural complications occurred in 9.8% of C-Arm cases (vs. 2.7% Hybrid, 2.4% IR, P=0.09), with all strokes (3) in C-Arm cases (P=0.04). On multivariate regression, C-Arm was an independent predictor of complications vs fixed imaging (OR 5.7, 95% CI 4.9-6.6, P=0.05).

Conclusions: Despite technological advances, TEVAR for BTAI is still frequently performed in a standard OR with C-Arm imaging, rather than with a fixed imaging system in a hybrid operating room or IR suite. C-Arm procedures take longer and have higher complication rates, including stroke. TEVAR for BTAI is most safely conducted using a fixed imaging system in a hybrid OR setting.