Post-Endovascular Rx of Thoracic Aortic Injury

An axial CT image shows a normal appearance of an endovascular stent in the descending thoracic aorta in a patient who suffered thoracic aortic injury.

Facts: Treatment and Follow Up of Thoracic Aortic Injury (TAI)

• Open thoracotomy with direct repair of TAI is a traditional means for Rx of TAI. However, endovascular Rx has become more common given its less invasiveness and many reports demonstrating smaller mortality rate
• Endovascular Rx is used to exclude pseudoaneurysm from systemic arterial pressure
• Patients who had endovascular Rx for TAI will require regular imaging follow-ups. Most institutions perform CT angiography at the time of discharge, at 1-3 months, at 6 months, at 1 year and then annually.
• Purpose of follow up CT angiography after endovascular Rx is to 1) assess quality of pseudoaneurysm exclusion, 2) detect related complications
• Complications potentially detectable on imaging (rare): endoleak, graft collapse, branch vessel complications (stroke, arm ischemia), stent migration, etc

Normal Imaging Findings

• Endograft = metallic framework with a zigzag appearance (covered by polytetrafluorethylene or polyester material)
• Must compare the CT angiography with prior angiography (post-stent) or prior post-operative CT
• Check for position of endograft (should be unchanged), apposition/seal with the aortic wall (should be completely sealed), patent endograft lumen (without narrowing or sharp angulation), total exclusion of aortic injury

Reference

Morgan TA, Steenburg SD, Siegel EL, Mirvis SE. Acute traumatic aortic injuries: posttherapy multidetector CT findings. Radiographics 2010; 30:851-867