OBJECTIVE: Blunt thoracic aortic injuries (BTAIs) involving the aortic arch are a challenging condition. Thoracic endovascular aortic repair (TEVAR) with fenestration, which expands the proximal landing zone, is able to exclude the injury while preserving blood flow in supra-aortic branches.
METHODS: Here we report a case of TEVAR with fenestrations of all supra-aortic branches for traumatic aortic pseudoaneurysm and perform a systematic review.
RESULTS: A 24-year-old man suffering a blunt thoracic injury and a left femoral fracture was sent to our hospital. A pseudoaneurysm was found in the aortic arch between the brachiocephalic artery and the left common carotid artery. The patient underwent emergent TEVAR with fenestrations of all supra-aortic branches, which excluded the pseudoaneurysm and preserved the patency of all branches. The orthopedic team then treated the femoral fracture. The patient\'s recovery was unremarkable. We performed a systematic review on TEVAR with fenestrations for BTAI. Six patients (75%) received TEVAR with single fenestration, 1 patient (12.5%) received TEVAR with two fenestrations, and 1 patient (12.5%) had fenestrations of all supra-aortic branches. Except one patient died in the perioperative, other patients survived without stent-related complications in the short-term follow-up.
CONCLUSIONS: TEVAR with fenestration is feasible for treating BTAI involving the aortic arch in selected patients.

UNASSIGNED: This study aimed to assess the long-term outcomes in patients treated by thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injuries (BTAI).
UNASSIGNED: From January 2010 to December 2019, this retrospective observational study was conducted at 3 centers, involving 62 consecutive BTAI patients who underwent TEVAR. Computed tomography angiography scans were planned to be conducted at 6 months post-procedure, and annually thereafter.
UNASSIGNED: Technical success was achieved in all 62 procedures (100%), which included cases of dissection (n=35, 56.45%), pseudoaneurysm (n=20, 32.26%), and rupture (n=7, 11.29%). Mean injury severity score was 31.66±8.30. A total of 21 supra-arch branches were revascularized by chimney technique, with 12 cases involving the left subclavian artery (LSA) and 9 cases involving the left common carotid artery. In addition, 11 LSAs were covered during the procedure. The in-hospital mortality rate was 1.61% (n=1). The mean follow-up time was 86.82±30.58 months. The all-cause follow-up mortality rate was 3.28% (n=2). Stenosis or occlusion of 3 supra-arch branches (4.92%) was identified at follow-up, with 2 cases (3.28%) requiring re-intervention. No spinal cord ischemia, endoleak, or migration was observed.
UNASSIGNED: Despite only including patients with long-term follow-up, this study confirms the long-term safety and effectiveness of TEVAR for BTAI. For young BTAI patients, as the thoracic aorta increases with age, longer follow-up is needed to observe the potential mismatch between the endograft and the aorta.
CONCLUSIONS: This study confirms the long-term safety and effectiveness of endovascular treatment for blunt thoracic aortic injury (BTAI). For young BTAI patients, as the thoracic aorta increases with age, longer follow-up is needed to observe the potential mismatch between the endograft and the aorta. Through a remarkably extended follow-up period (86.82±30.58 months) conducted at multiple centers in China, this study confirms the long-term safety and effectiveness of endovascular treatment for BTAI.

OBJECTIVE: To explore the effectiveness of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) with hostile stent-graft proximal landing zone.
METHODS: A retrospective analysis was made on the clinical data of 13 patients with BTAI with hostile stent-graft proximal landing zone treated by TEVAR between December 2007 and December 2014. There were 10 males and 3 females with the mean age of 44 years (range, 24-64 years). The imaging examination indicated Stanford type B aortic dissection in 7 cases, pseudoaneurysm in 3 cases, aneurysm in 1 case, and penetrating ulcer in 2 cases. According to the partition method of thoracic aortic lesion by Mitchell, 8 cases underwent stent-graft with left subclavian artery (LSA) coverage, 3 underwent chimney stents for LSA, and 2 for left common carotid artery (LCCA). In 2 cases receiving chimney TEVAR involving LCCA, one underwent steel coils at the proximal segment of LSA to avoid type II endoleak and the other underwent in situ fenestration for endovascular reconstruction of LSA.
RESULTS: All TEVAR procedures were successfully performed. The mean operation time was 1.8 hours (range, 1-3 hours); the mean intraoperative blood loss was 120 mL (range, 30-200 mL); and the mean hospitalization time was 15 days (range, 7-37 days). No perioperative death and paraplegia occurred. The patients were followed up 3-30 months (mean, 18 months). Type I endoleak occurred in 1 case during operation and spontaneously healed within 6 months. Hematoma at brachial puncture site with median nerve compression symptoms occurred in 1 case at 3 weeks after operation; ultrasound examination showed brachial artery pseudoaneurysm and thrombosis, and satisfactory recovery was obtained after pseudoaneurysmectomy. No obvious chest pain, shortness of breath, left upper limbs weakness, numbness, and dizziness symptoms were observed. Imaging examination revealed that stentgraft and branched stent remained in stable condition. Meanwhile the blood flow was unobstructed. No lesions expanded and ruptured. No new death, bacterial infection, or other serious complications occurred.
CONCLUSIONS: According to Mitchell method, individualized plan may be the key to a promising result. More patients and further follow-up need to be included, studied, and observed.
UNASSIGNED: 探讨胸主动脉腔内修复术（thoracic endovascular aortic repair，TEVAR）治疗覆膜支架近端锚定区不良的胸主动脉钝性伤（blunt thoracic aortic injury，BTAI）的临床疗效。.
UNASSIGNED: 回顾分析2007年12月-2014年12月采用TEVAR治疗的13例覆膜支架近端锚定区不良的BTAI患者临床资料。其中男10例，女3例；年龄24～64岁，平均44岁。术前影像学检查提示Stanford B型主动脉夹层7例，假性动脉瘤3例，动脉瘤1例，穿透性溃疡2例。根据支架近端锚定区Mitchell分区位置不同，单纯行覆膜支架置入覆盖左锁骨下动脉（left subclavianartery，LSA）8例；烟囱技术重建LSA 3例；烟囱技术重建左颈总动脉2例（其中1例采用弹簧圈栓塞LSA起始部以避免Ⅱ型内漏，1例采用原位开窗技术重建LSA）。.
UNASSIGNED: 手术均顺利完成，手术时间1～3 h，平均1.8 h；术中出血量30～200 mL，平均120 mL；住院时间7～37 d，平均15 d。无围手术期死亡、截瘫发生。13例均获随访，随访时间3～30个月，平均18个月。术中发生Ⅰ型内漏1例（7.7%），未予以特殊处理，于术后6个月自愈；1例术后3周出现穿刺部位皮下血肿，伴正中神经压迫症状，超声检查提示肱动脉假性动脉瘤并血栓形成，行肱动脉假性动脉瘤切除术，术后恢复尚可。所有患者术后未见明显胸背痛、憋气、左上肢乏力、麻木及头晕等症状；影像学检查提示主体及分支支架血流通畅；未见支架移位，无病变处扩张和破裂等；无新发死亡及细菌感染等严重并发症。.
UNASSIGNED: 根据Mitchell分区法设计个性化方案，采用TEVAR治疗覆膜支架近端锚定区不良的BTAI具有良好的近期临床效果，远期结果有待进一步随访。.