Objective: This retrospective, multicentre, observational study analysed patients who underwent endovascular repair for blunt traumatic aortic injury (BTAI) at four tertiary trauma referral centres over twenty years. It aimed to determine early and long term survival, to analyse aortic and device related complications, and to assess the re-intervention rate after endovascular repair for BTAI.

Methods: All patients treated from 1 January 2001 to 31 October 2021 were identified using local hospital registries and two national registries: the Swedish vascular registry (Swedvasc) and Swedish trauma registry (SweTrau). Patient, treatment, and follow up data were extracted from medical records and radiology data by review of congregated imaging. The report was structured according to the STROBE checklist.

Results: Ninety five patients were included: 80 were male (84%), the median age was 42 years (interquartile range [IQR] 27, 64), and median follow up time was 6.1 years (IQR 0.7, 12.4). The thirty day mortality rate was 16% (15 of 93), 40% of these were caused by traumatic brain injury and 33% by aortic related causes. Estimated overall survival was 57% (standard error 6.6) at fifteen years after index treatment. Aortic re- intervention procedures (re-stenting, coiling, or explantation) were performed in 14 of 86 patients (16%), six of whom underwent stent graft explantation. Seven of the 14 patients (50%) who underwent aortic re- intervention presented with symptoms and six of 14 had a device related complication. All complications that required aortic re-intervention were diagnosed within eighteen months of the index procedure. There was no association between injury grade and aortic re-intervention.

Conclusion: Thoracic endovascular aortic repair is an effective treatment for patients with BTAI needing intervention. It carries low rates of device related complications and death, and the long term outcomes are acceptable. As all aortic complications requiring re-intervention were identified during the first two years after index treatment, with half of the patients reporting symptoms, future follow up protocols should be adjusted accordingly.