Trauma Centers Can Optimize Inventory for TEVAR After Blunt Thoracic Trauma

Mendizabal FY, MacHugh A, Crapps J, Hutzler J, et al. Value-Based Approach to Stent-Graft Inventory Selection for Blunt Thoracic Aortic Injury: Multi-Center, Multi-Manufacturer Analysis from the Aortic Trauma Foundation. J Am Coll Surg. July 2026.

Thoracic endovascular aortic repair (TEVAR) is the standard treatment for blunt thoracic aortic injury (BTAI), but maintaining extensive thoracic stent-graft inventories is costly and logistically challenging. The researchers evaluated whether a limited, anatomy-based inventory could accommodate most BTAI repairs.

The Aortic Trauma Foundation registry was queried for patients with BTAI undergoing TEVAR at 52 trauma centers worldwide from January 2012 to January 2024. Patients with documented initial computed tomography aortic measurements, stent-graft manufacturer, and device size were included. Stent-grafts were ranked by utilization frequency within each manufacturer to determine the minimum number of configurations required to treat at least 90% of patients.

Among 346 patients, 80% were male, and the mean age was 41 ± 15 years. Device utilization was greatest for Gore (60%), followed by Medtronic (21%), Cook (12%), and Terumo (6%). Although each manufacturer offered more than 20 thoracic stent-graft options, the six most frequently used configurations treated 91–97% of patients across manufacturers and spanned proximal diameters of 21–32 mm. Of 36 patients (10%) requiring devices outside these configurations, 83% still underwent repair using proximal diameters within the 21–32 mm range. Only 7 patients (2%) required proximal diameters >32 mm; these patients were older (73.6 versus 41 years) and had larger native aortic diameters. Overall, proximal diameters of 21–32 mm encompassed 98.3% of repairs. BTAI grade, endoleak repair rates, and in-hospital mortality did not differ among manufacturers.

Six stent-graft configurations spanning proximal diameters of 21–32 mm can accommodate more than 90% of BTAI TEVAR procedures, while only 2% of patients require larger devices. These findings support evidence-based inventory optimization for trauma centers establishing or maintaining TEVAR capability.