Aortic and cardiovascular remodelling after thoracic endovascular aortic repair for blunt traumatic aortic injury in younger patients - A narrative review of physiological and clinical outcomes

Sep 28, 2026

Blunt traumatic aortic injury (BTAI) is severe and often fatal in younger populations, making thoracic endovascular aortic repair (TEVAR) a major therapeutic shift beyond open surgical repair. The narrative review details key post-TEVAR physiological changes in aortic size, shape, compliance, and flow, including loss of the Windkessel effect, higher pulse wave velocity, reduced radial strain, and altered cardiovascular hemodynamics. These changes may increase hypertension risk, left ventricular dysfunction, coronary disease, and complications such as graft migration, while clinical outcomes generally show reduced mortality and cerebrovascular accidents. Long-term durability and the need for re-interventions remain critical concerns, motivating improved endografts and stent strategies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Introduction

TEVAR vs OSR in BTAI

Physiological concerns and long-term challenges

DOI: 10.1113/EP092615 REVIEW ARTICLE Aortic and cardiovascular remodelling after thoracic endovascular aortic repair for blunt traumatic aortic injury in younger patients: A narrative review of physiological and clinical outcomes Marco David Bokobza De la Rosa1 Matti Jubouri2 Thurkga Moothathamby3 Mohamed Refaie4 Ali Murtada4 Idhrees Mohammed5 Ian M. Williams6 Damian M. Bailey7 Mohamad Bashir7 1 Lancaster Medical School, University of Lancaster, Lancaster, UK 2 Hull York Medical School, University of York, York, UK 3 Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK 4 Department of General Surgery, Ysbyty Glan Clwyd, Rhyl, Wales 5 Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India 6 Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK 7 Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK Correspondence Damian M. Bailey, Professor of Physiology and Biochemistry, Director of the Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, UK. [Email:](Email: damian.bailey@southwales.ac.uk)[ damian.bailey@southwales.ac.uk](Email: damian.bailey@southwales.ac.uk) Funding information D.M.B. is supported by the Royal Society Wolfson Research Fellowship (\#WM170007). Handling Editor: Toby Mundel Abstract Blunt traumatic aortic injury (BTAI) is severe, often fatal in younger populations due to high-energy deceleration mechanisms. Thoracic endovascular aortic repair (TEVAR) has revolutionised BTAI treatment, surpassing the previously standard open surgical repair in mortality and complication rates. Despite its success, concerns arise regarding TEVAR’s long-term effects, especially in younger BTAI patients. Key physiological changes following TEVAR include alterations in aortic size, shape, compliance and flow dynamics, leading to loss of the Windkessel effect and a consequent increased pulse wave velocity and decreased radial strain, which can contribute to the development of hypertension. These alterations also predispose patients to changes in cardiovascular flow (increased reverse systolic flow, reduced maximum velocity and altered helical flow), potentially increasing the risk of left ventricular dysfunction and coronary artery disease. Physiological changes also increase the likelihood of complications such as graft migration. Clinical outcomes of TEVAR for BTAI have generally been favourable, with significant reductions in mortality and cerebrovascular accident rates compared to open surgical repair. However, longterm complications, including the need for re-interventions, remain a concern, though studies suggest these are infrequent. The durability ofTEVARin younger patients, who may experience decades of device use, poses unique challenges, particularly due to the natural progression of aortic morphology over time. Therefore, adapting TEVAR to the physiological needs of younger BTAI patients is essential. Developing more compliant endografts and using shorter stents with improved materials can help minimise structural and haemodynamic changes and enhance cardiovascular outcomes, supporting the long-term health of this vulnerable population. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society. BOKOBZA DE LA ROSA ET AL. KEYWORDS aortic physiology, aortic remodelling, aortic surgery, BTAI, cardiothoracic, TEVAR 1 INTRODUCTION Blunt traumatic aortic injury (BTAI) is a devastating vascular lesion with markedly high mortality rates, culminating ina pre-hospitalisation death

FAQs

What is the main clinical problem addressed in this review?

The review addresses blunt traumatic aortic injury in younger patients and how thoracic endovascular aortic repair affects long-term physiological and clinical outcomes.

What physiological changes after TEVAR may contribute to later cardiovascular complications?

Changes in aortic size, compliance, and flow dynamics can include loss of the Windkessel effect, increased pulse wave velocity, decreased radial strain, and altered cardiovascular flow, potentially contributing to hypertension and other cardiac risks.

How do clinical outcomes of TEVAR compare with open surgical repair for BTAI?

Clinical outcomes are generally favourable with significant reductions in mortality and cerebrovascular accident rates compared with open surgical repair, although long-term issues like re-interventions are still a concern.

Sep 28, 2026

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