Delayed versus Early TEVAR in Grade III Blunt Traumatic Aortic Injury: A 12-Year Single-Center Retrospective Study

Background: This study aimed to summarize a 12-year single-center experience in managing Grade III blunt traumatic aortic injury (BTAI) and compare the safety and efficacy of delayed thoracic endovascular aortic repair (TEVAR) with early intervention. Methods: A retrospective analysis of 56 patients with Grade III BTAI treated between August 2011 and January 2024 was conducted. Based on clinical condition, patients received early TEVAR (<24h), delayed TEVAR (>24h), or conservative management. Perioperative and follow-up outcomes were assessed. Results: Among the 56 patients, 16 underwent early TEVAR, 37 delayed TEVAR, and 3 conservative treatment. The average age was 49.4 years, and 75.0% were male. Motor vehicle collisions were the leading cause (60.7%). Common associated injuries included fractures (94.6%), pulmonary (64.3%), and cranial injuries (41.1%). The early TEVAR group had significantly higher Injury Severity Scores (ISS), shock index >1, and emergency surgery rates (all p<0.01). There were no significant differences in perioperative mortality or endoleak rates. No patients experienced paraplegia, cardiovascular events, or renal impairment. Aortic-related hospital stays were shorter in the early TEVAR group (p<0.001), which also had a higher rate of post-TEVAR surgeries for associated injuries (p=0.006). Follow-up revealed no significant differences in all-cause survival or reoperation rates between groups. No aortic-related deaths occurred in either group. Conclusion: Delayed TEVAR is not inferior to early TEVAR for Grade III BTAI in terms of safety and efficacy. Both approaches achieved favorable outcomes when individualized to patient hemodynamic status and injury severity.