The Importance of Conformability and Sizing in TEVAR

T he management of patients who suffer blunt aortic injury (BAI) has drastically changed since the approval of stent grafts to treat aortic disease. At most major trauma centers, thoracic endovascular aortic repair (TEVAR) has now become the treatment of choice.1 With the recent approval of the Conformable GORE® TAG® Device (Gore & Associates, Flagstaff, AZ) for isolated lesions, BAI is now an on-label treatment option for patients. Although these devices were originally designed for treating aneurysmal disease, they have found success in treating BAI.2 However, distinct differences exist between these two patient populations. Based on clinical trial data from the United States,3-5 the average age of patients who are treated with TEVAR for thoracic aortic aneurysms is 71 years. In comparison, the average patient age is 40 years in 100 patients treated at the University of North Carolina during the past 20 years who presented with a traumatic aortic injury. As individuals age, not only does the aorta enlarge, but the radius of curvature also increases. Whether this is the result of increases in aortic stiffness or a natural process is difficult to determine. It does, however, have a significant impact on device performance in the proximal thoracic aorta. Despite the overwhelming acceptance of TEVAR for treating BAI, when planning these procedures, there are certain aspects to be aware of, which are crucial to achieving successful outcomes; most notably, these are device sizing and conformability.