Endovascular Rescue for Blunt Trauma Aortic Injury

Outcomes of a trial to assess thoracic endovascular repair in blunt traumatic aortic injury (BTAI) was presented by Ali Azizzadeh, MD, professor and director of the Division of Vascular Surgery and associate director of the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles, California. A surgeon with expertise in the endovascular treatment of thoracic aortic disease, Dr. Azizzadeh’s center participated in the Clinical PeRformancE of the Valiant Thoracic Stent Graft with Captivia Delivery System for the EndovaSCUlar treatment of Blunt Thoracic Aortic Injuries (RESCUE) Trial.

The trial evaluated the performance of the Valiant Thoracic Stent Graft with Captivia Delivery System from Medtronic in the treatment of patients with BTAI. The patients were followed for 5 years to determine the durability of endovascular repair using this system.

Fifty patients (mean age 40.7 years; 76% male) were treated for BTAI, the second leading cause of mortality from nonpenetrating trauma in the United States. Seventy percent of blunt thoracic aortic injury extent was grade III or higher, according to Dr. Azizzadeh. The results were promising.

“The RESCUE clinical trial demonstrates excellent 5-year outcomes and durable exclusion of blunt thoracic aortic injury using Valiant Captivia,” he said. “Complete exclusion of the traumatic injury was maintained with no incidences of stent graft kinking, fracture, loss of patency, or migration through 5 years in all patients.” 

Speaking about the motivation for the trial, Dr. Azizzadeh said his team had previously reported early results of thoracic endovascular aneurysm repair (TEVAR) for BTAI with the device. “The broad worldwide use of Valiant Captivia in all descending thoracic aortic pathologies continues to validate this minimally invasive option for physicians,” he underlined. However, although national data suggest that early outcomes are better with TEVAR, late results–particularly in aortic pathologies frequently occurring in the younger patient population–have been less understood. 

In conclusion, Dr. Azizzadeh said durability of this intervention has been established. “Based on the 5-year results of the RESCUE trial, TEVAR with Valiant Captivia is a safe, effective, and durable treatment option for patients with blunt thoracic aortic injury.”