Blunt traumatic thoracic aortic injury is associated with a high mortality rate, and has been implicated as the second most common cause of death in trauma patients, behind only to intracranial hemorrhage. It has been estimated that less than 25% of patients with such an injury live to be evaluated in a hospital,3 and of those who do, up to 50% will die within 24 hours.

Historically, open repair of traumatic aortic injuries has been associated with a 28% mortality rate and a 16% paraplegia rate. There has been a risk of delayed rupture in the unrepaired thoracic transection that has been estimated to be 2% to 5%.

Thoracic endovascular aortic repair (TEVAR) involves placing an endovascular stent graft into the thoracic aorta from a remote peripheral location under imaging guidance. TEVAR offers the potential for a durable aortic repair while avoiding the morbidity of a thoracotomy, aortic cross clamping, and cardiopulmonary bypass. Nevertheless, stroke, spinal cord ischemia, and other complications that are associated with open repair can also occur with TEVAR.

There remains a number of unresolved issues related to endovascular repair of traumatic thoracic aortic injuries:

1. Poor conformation to the arch
2. Frequent need to cover the left subclavian artery (LSA)
3. Uncertain natural history of the repair given the younger age of trauma victims and the morphologic changes of the aorta that come with age
4. Optimal follow-up strategy that may span several decades and the risks of cumulative radiation exposure
5. Timing of repair
6. The need for intraoperative anticoagulation in the setting of polytrauma