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

Delayed versus Early TEVAR in Grade III Blunt Traumatic Aortic Injury: A 12-Year Single-Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Delayed versus Early TEVAR in Grade III Blunt Traumatic Aortic Injury: A 12-Year Single-Center Retrospective Study Qi Qin, Lun-Chang Wang, Quan-Ming Li, Ming Li, Hao He, Xin Li, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6744825/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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), 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. Blunt traumatic aortic injury Thoracic endovascular aortic repair Surgical timing Figures Figure 1 Figure 2 Figure 3 1. Background Blunt traumatic aortic injury (BTAI) is a rare but life-threatening condition, most commonly tearing at the aortic isthmus. It is primarily caused by high-impact mechanisms such as motor vehicle collisions or falls from height. As the second leading cause of death in trauma patients, BTAI often presents alongside multiple injuries, making clinical diagnosis and management more complex [ 1 – 3 ] . The most widely adopted grading system for BTAI is based on imaging findings and stratifies injuries by severity: Grade I manifests as intimal tears, intimal flaps, or both; Grade II as intramural hematoma; Grade III as aortic wall disruption with pseudoaneurysm; and Grade IV as aortic wall disruption with free rupture [ 4 , 5 ] . Current guidelines recommend conservative management with serial imaging for Grade I-II injuries. Surgical intervention is advised for Grade II injuries complicated by a posterior mediastinal hematoma > 10 mm or compressive hematoma, and is considered mandatory for Grades III-IV unless contraindicated [ 3 ] . Thoracic endovascular aortic repair (TEVAR) has become the first-line surgical choice, but controversy persists regarding the optimal timing of TEVAR. Earlier guidelines suggested surgical repair within 24 hours of injury (early TEVAR) to reduce the risk of aortic rupture-related death [ 5 ] . In recent years, increasing evidence has shown that delayed or elective TEVAR (performed more than 24 hours after injury) significantly reduces perioperative mortality compared to early TEVAR [ 6 – 9 ] . Current guidelines have not yet established a definitive consensus regarding the ideal timing for TEVAR, indicating the need for further clinical investigation—particularly in cases of Grade III BTAI involving pseudoaneurysm. This study aimed to summarize 12 years of single-center experience and evaluate the safety and efficacy of early versus delayed TEVAR in patients with Grade III BTAI, providing further clinical insight into optimal surgical timing. 2. Methods This retrospective study included patients with Grade III BTAI admitted to our center between August 2011 and January 2024. Grade III BTAI was defined as aortic wall disruption with pseudoaneurysm formation by the Society for Vascular Surgery (SVS) clinical practice guideline [ 5 ] . The patient selection flowchart is presented in Fig. 1 . Baseline characteristics of patients, such as age, gender, trauma types, medical history, associated injuries, complications, Intensive severe scores (ISS) were obtained from medical records. Hemodynamic parameters including systolic and diastolic blood pressure (BP), heart rate, and shock index (SI) were recorded, with SI calculated as the ratio of heart rate to systolic blood pressure. Data on surgical details, mortality, postoperative complications such as endoleak, paraplegia, stroke, myocardial infraction, renal failure were collected. Hospitalization metrics included total length of hospital stay, length of hospital stay for aortic disease, and intensive care unit (ICU) stay durations. Post-discharge follow-up was conducted through outpatient clinic visits and telephone interviews. Outpatient follow-up included clinical symptoms, physical examinations, and aortic CTA, while telephone follow-up focused on the patient's health status, new aortic-related conditions, and whether a secondary surgery had been performed. Statistical analysis was conducted using SPSS 26.0 software. Quantitative variables were described as mean ± standard deviation (SD) or median (M) and compared using an independent sample t-test or non-parametric rank-sum test. Qualitative variables were described as frequencies (n) and proportions (%), and comparisons were made using the chi-squared (χ²) test or non-parametric rank-sum test. A p -value < 0.05 indicated statistical significance. 3. Results 3.1. General Characteristics of Patients A retrospective analysis was conducted on these 56 patients, with the majority whom were male (75%). The patients ranged in age from 19 to 80 years, with a mean age of 49.57 ± 16.06 years. Patients under 40 years old accounted for 26.8% of the cohort. The main cause of trauma was car accidents (60.7%), followed by falls (25%) and other types of blunt trauma (14.3%). A history of cardiovascular disease was relatively uncommon in this population. Hypertension was present in 21 patients (37.5%), while only 1 patient (1.8%) had a history of coronary artery disease, and none had a history of cerebral infarction. Among the 56 patients with Grade III BTAI, 3 patients did not undergo surgical treatment and were categorized into the non-surgical group. The remaining 53 patients underwent TEVAR after admission. Based on the time interval from injury to surgery, 16 patients were included in the early TEVAR group ( 24h). There were no statistically significant differences in the clinical characteristics between the early and delayed TEVAR groups. (Table 1 ) Table 1 Baseline characteristics of patients with grade III BTAI All BTAI(n = 56) Early TEVAR(n = 16) Delayed TEVAR(n = 37) Non-surgical group(n = 3) P Value (Comparison of early TEVAR vs. delayed TEVAR) Age (year) 49.57 \(\:\pm\:\) 16.06 46.31 \(\:\pm\:\) 15.50 51.19 \(\:\pm\:\) 15.74 47.00 \(\:\pm\:\) 26.23 0.295 Gender Male 42(75.0) 12(75.0) 29(78.4) 1(33.3) 0.787 Trauma types Falling injury 14(25.0) 2(12.5) 11(29.7) 1(33.3) 0.402 Traffic accident 34(60.7) 11(68.8) 21(56.8) 2(66.7) 0.402 Others a 8(14.3) 3(18.8) 5(13.5) 0(0) 0.402 Medical history Hypertension 21(37.5) 6(37.5) 13(35.1) 2(66.7) 0.869 Coronary artery Disease 1(1.8) 0(0) 1(2.7) 0(0) 0.507 Cerebral Infarction 0(0) 0(0) 0(0) 0(0) / a including blast injury, blunt force trauma BTAI, blunt traumatic aortic injury; TEVAR, thoracic endovascular aortic repair All data are presented as mean \(\:\pm\:\) standard deviation or number (%). 3.2. Clinical Presentations and Imaging Characteristics of Patients All 56 patients sustained multiple traumatic injuries, with fractures (94.6%), lung injuries (64.3%), and cranial injuries (41.1%) being the most common. Renal (17.9%) and hepatic (10.7%) injuries were less frequent. Pleural effusion was observed in 46 cases (82.1%), including 6 cases (10.7%) with large-volume effusion, and pericardial effusion in 7 cases (12.5%). Four patients (7.1%) were admitted in a comatose state, including 3 cases (8.1%) in the delayed TEVAR group and 1 case (33.3%) in the non-surgical group. No cases of preoperative paraplegia were recorded. There were no statistically significant differences in clinical presentations between the early and delayed TEVAR groups. However, the ISS at admission averaged 30.57 ± 5.61 points across all patients, with significantly higher scores in the early TEVAR group compared to the delayed TEVAR group (32.56 ± 3.67 vs. 29.19 ± 4.81, p = 0.004 ) (Table 2 ). Following initial stabilization at the trauma center, the systolic blood pressure on admission was 137.43 ± 23.96 mmHg, diastolic blood pressure was 80.96 ± 11.89 mmHg, and heart rate was 89.96 ± 15.98 beats per minute. These findings suggest that while hypertension is not the primary cause of BTAI, most patients present with hypertensive crises upon arrival. The shock index (SI), calculated as heart rate divided by systolic pressure, exceeded 1.0 in 7 patients (12.5%). Among them, 5 cases (31.3%) were in the early TEVAR group and 2 cases (66.7%) in the non-surgical group. The proportion of SI > 1 was significantly higher in the early TEVAR group than in the delayed group ( p = 0.002 ), suggesting that the timing of TEVAR should consider the patient's hemodynamic status, with early TEVAR recommended when hemodynamically unstable. CTA imaging revealed the aortic isthmus as the rupture site in 48 cases (85.7%), consistent with typical BTAI patterns, with no significant difference in distribution between groups. No statistically significant differences were found in rupture site distribution between the early and delayed TEVAR groups (Table 2 ). Table 2 Clinical Presentation and CTA Imaging Characteristics of Patients All BTAI(n = 56) Early TEVAR(n = 16) Delayed TEVAR(n = 37) Non-surgical group(n = 3) P Value (Comparison of early TEVAR vs. delayed TEVAR) Associated injuries Bone fracture 53(94.6) 15(93.8) 35(94.6) 3(100) 0.903 Lung injuries 36(64.3) 11(68.8) 22(59.5) 3(100) 0.522 Cranial injuries 23(41.1) 7(43.8) 15(40.5) 1(33.3) 0.828 Renal injuries 10(17.9) 2(12.5) 6(16.2) 2(66.7) 0.729 Hepatic injuries 6(10.7) 1(6.3) 4(10.8) 1(33.3) 0.602 Complications Pleural effusion 46(82.1) 15(93.8) 28(75.7) 3(100) 0.123 large-volume effusion 6(10.7) 1(6.3) 5(13.5) 0(0) 0.444 Pericardial effusion 7(12.5) 2(12.5) 4(10.8) 1(33.3) 0.859 Coma 4(7.1) 0(0) 3(8.1) 1(33.3) 0.241 Preoperative paraplegia 0(0) 0(0) 0(0) 0(0) / ISS 30.57 \(\:\pm\:\) 5.61 32.56 \(\:\pm\:\) 3.67 29.19 \(\:\pm\:\) 4.81 37.00 \(\:\pm\:\) 14.80 0.004 Hemodynamics Systolic BP (mmHg) 137.43 \(\:\pm\:\) 23.96 133.63 \(\:\pm\:\) 29.60 139.95 \(\:\pm\:\) 19.97 126.67 \(\:\pm\:\) 40.42 0.367 Diastolic BP (mmHg) 80.96 \(\:\pm\:\) 11.89 77.19 \(\:\pm\:\) 11.32 83.14 \(\:\pm\:\) 11.79 74.33 \(\:\pm\:\) 12.66 0.094 Heart rate 89.96 \(\:\pm\:\) 15.98 92.69 \(\:\pm\:\) 12.62 87.16 \(\:\pm\:\) 16.39 110.00 \(\:\pm\:\) 13.75 0.235 SI>1 7(12.5) 5(31.3) 0(0) 2(66.7) 0.002 Primary intimal tear location Aortic isthmus 48(85.7) 16(100.0) 29(78.4) 3(100.0) 0.088 Others a 8(14.3) 0(0) 8(21.6) 0(0) 0.088 a including proximal descending aorta, ascending aorta, aortic arch, distal descending aorta. BTAI, blunt traumatic aortic injury; TEVAR, thoracic endovascular aortic repair; ISS, injury severity score; BP, blood pressure; SI, shock index All data are presented as mean \(\:\pm\:\) standard deviation or number (%). 3.3. Treatment Strategies and Perioperative Outcomes According to early international guidelines, TEVAR is recommended within 24 hours for Grade III or higher BTAI. In our cohort, 16 patients received emergency early TEVAR within 24 hours after admission, mainly due to hemodynamic instability, progression of aortic injury on CTA, or the need for urgent surgery for associated injuries. In contrast, the 37 patients in the delayed TEVAR group were primarily admitted more than 24 hours post-trauma and were hemodynamically stable. All 53 patients who underwent TEVAR received general anesthesia and intraoperative heparin, with a 100% technical success rate. Emergency surgeries were performed in all 16 in the early TEVAR group (100%) while none in the delayed TEVAR group underwent emergency procedures, showing a statistically significant difference ( p < 0.001 ). The mean surgical duration for all 53 patients was 1.18 ± 0.50 hours, with no significant difference between the early (1.22 ± 0.51 hours) and delayed TEVAR groups(1.16 ± 0.50 hours), suggesting comparable surgical complexity between the two groups. Arch branch reconstruction was performed in 12 patients (22.6%), with comparable rates in both groups, reflecting a higher rate of arch branch reconstruction related to the location of the injury predominantly at the aortic arch. Figure 2 illustrates the comparison of preoperative and postoperative CTA results between the two groups. Perioperative mortality was slightly higher in the early TEVAR group (6.3% vs 0%, p > 0.05 ), with one death due to refractory acidosis following shock. No myocardial infarction, stroke, paraplegia or unplanned reintervention occurred in either group. Postoperative CTA follow-up revealed no endoleaks in the early TEVAR group, while two endoleaks (type II and IV) occurred in the delayed group (0% vs 5.4%, p > 0.05 ), both resolved spontaneously. Among patients who underwent arch branch reconstruction in both groups, follow-up results indicated patency of the branch stents without ischemic complications. In the non-surgical group, one patient died from sudden cardiac arrest on the first day of conservative treatment due to economic limitations, while another patient died from cerebral herniation secondary to severe traumatic brain injury. Aortic-related hospital stay was significantly shorter in the early TEVAR group (9.13 ± 4.63 days vs 15.95 ± 5.85 days, p < 0.001 ), possibly reflecting the greater need for secondary non-vascular surgeries in the early TEVAR group. However, the total length of hospital stay and ICU stay duration showed no significant difference (Table 3 ). Table 3 Treatment Strategies and Perioperative Outcomes All BTAI(n = 53) Early TEVAR(n = 16) Delayed TEVAR(n = 37) P Value Surgical Details Surgical success 53(100) 16(100) 37(100) / Emergency surgeries 16(30.2) 16(100) 0(0) \(\:<\) 0.001 General anesthesia 53(100) 16(100) 37(100) / Intraoperative use of heparin 53(100) 16(100) 37(100) / Surgery duration (hour) 1.18 \(\:\pm\:\) 0.50 1.22 \(\:\pm\:\) 0.51 1.16 \(\:\pm\:\) 0.50 0.907 LSA arch branch reconstruction 12(22.6) 4(25.0) 8(21.6) 0.787 LCCA stenting 1(1.9) 0(0) 1(2.7) 0.507 Main stents count 1.32 \(\:\pm\:\) 0.70 1.44 \(\:\pm\:\) 0.63 1.27 \(\:\pm\:\) 0.73 0.907 Perioperative mortality 1(1.9) 1(6.3%) 0(0) 0.125 Postoperative Complications Endoleak Type II 1(1.9) 0(0) 1(2.7) 0.507 Type IV 1(1.9) 0(0) 1(2.7) 0.507 Paraplegia 0(0) 0(0) 0(0) / Stroke 0(0) 0(0) 0(0) / Myocardial infarction 0(0) 0(0) 0(0) / Renal failure 0(0) 0(0) 0(0) / Unplanned reoperation 0(0) 0(0) 0(0) / Patency of the branch stents 53(100) 16(100) 37(100) / Hospital Stay Duration (day) Total length of hospital stay 20.00 \(\:\pm\:\) 11.95 22.25 \(\:\pm\:\) 15.52 19.03 \(\:\pm\:\) 10.13 0.535 Length of hospital stay for aortic disease 13.83 \(\:\pm\:\) 6.42 9.13 \(\:\pm\:\) 4.63 15.95 \(\:\pm\:\) 5.85 \(\:<\) 0.001 ICU stay durations 3.70 \(\:\pm\:\) 6.01 4.44 \(\:\pm\:\) 5.49 3.38 \(\:\pm\:\) 6.27 0.156 BTAI, blunt traumatic aortic injury; TEVAR, thoracic endovascular aortic repair; LSA, left subclavian artery; LCCA, left common carotid artery; ICU, intensive unit care All data are presented as mean \(\:\pm\:\) standard deviation or number (%). To further investigate the potential impact of varying delay times within the delayed TEVAR group on outcomes, there is currently no clear staging for BTAI. We referred to the 2014 ESC Aortic Disease Guidelines and the Chinese consensus on aortic dissection staging [ 10 , 11 ] , dividing patients into three subgroups based on delayed days: 90 days(n = 2). Considering the limited sample size in > 90 days group, statistical analysis of the first two groups were performed and showed no significant difference in perioperative mortality or complication rates, suggesting that the acute-subacute transition period may not critically impact technical success, but prolonged delay was associated with significantly extended hospital stays (Table 4 ). Table 4 Subgroup analysis of Delayed TEVAR 90 days (n = 2) P Value (< 14 days vs. 14–90 days) Perioperative mortality 0(0) 0(0) 0(0) / Postoperative Complications Endoleak Type II 0(0) 1(5.6) 0(0) 0.324 Type IV 0(0) 0(0) 1(50) / Paraplegia 0(0) 0(0) 0(0) / Stroke 0(0) 0(0) 0(0) / Myocardial infarction 0(0) 0(0) 0(0) / Renal failure 0(0) 0(0) 0(0) / Hospital Stay Duration (day) Total length of hospital stay 19.24 \(\:\pm\:\) 10.24 19.33 \(\:\pm\:\) 10.73 14.50 \(\:\pm\:\) 3.54 0.987 Length of hospital stay for aortic disease 15.71 \(\:\pm\:\) 4.50 16.17 \(\:\pm\:\) 7.56 14.50 \(\:\pm\:\) 3.54 0.960 ICU stay durations 3.82 \(\:\pm\:\) 6.78 3.33 \(\:\pm\:\) 6.20 0 0.881 ICU, intensive care unit. All data are presented as mean \(\:\pm\:\) standard deviation or number (%). 3.4. Management of Associated Injuries and Follow-Up Results Management of associated injuries represents a critical aspect of care in patients with BTAI. In our cohort, the overall surgical intervention rate for associated injuries was 32.1%. In the delayed TEVAR group, 6 patients underwent emergency surgeries before TEVAR, including cranial, abdominal, and orthopedic procedures. After TEVAR, 12 patients required additional surgeries, with a higher rate in the early TEVAR group (50.0% vs. 10.8%, p = 0.006 ). This finding suggests a higher incidence of secondary surgical interventions for associated injuries post-TEVAR in the early TEVAR group. Successful CTA follow-up was achieved in 49 patients (92.5%) with a median duration of 13.4 months, and telephone follow-up was successful in 41 patients (77.4%) with a median duration of 37 months. The survival rate was 100% in the early TEVAR group and 92.3% in the delayed group, with no aortic-related deaths. Two endoleaks in the delayed group resolved spontaneously, and one patient required open surgery for retrograde type A dissection. No reinterventions were required in the early TEVAR group. None of these differences reached statistical significance. One non-surgical patient remained alive at 3 years (Table 5 ). Table 5 Management of Associated Injuries and Follow-up Outcomes All BTAI(n = 56) Early TEVAR9(n = 16) Delayed TEVAR(n = 37) Non-surgical group(n = 3) P Value (Comparison of early TEVAR vs. delayed TEVAR) Associated Injuries Surgeries 18(32.1) 8(50.0) 10(27.0) / 0.105 Before TEVAR 6(11.3) 0(0) 6(16.2) / 0.087 Cranial surgery 2(3.8) 0(0) 2(5.4) / 0.343 Orthopedic surgery 1(1.9) 0(0) 1(2.7) / 0.507 Exploratory laparotomy with visceral repair 2(3.8) 0(0) 2(5.4) / 0.343 Fracture and urethral repair 1(1.9) 0(0) 1(2.7) / 0.507 After TEVAR 12(22.6) 8(50.0) 4(10.8) / 0.006 Cranial surgery 0(0) 0(0) 0(0) / / Orthopedic surgery 11(20.8) 8(50.0) 3(8.1) / 0.002 Visceral surgery 0(0) 0(0) 0(0) / / Others 1(1.9) 0(0) 1(2.7) / 0.507 Follow-up(Total 53) Telephone follow-up 41(77.4) 14(87.5) 26(70.3) 1(100.0) / Median follow-up time(month) 37.0 26.0 48.0 37.0 / CTA follow-up 49(92.5) 14(93.3) 34(91.9) 1(100.0) / Median follow-up time(month) 13.4 14.5 12.1 36.0 / Survival 39(97.5) 14(100.0) 24(92.3) 1(100.0) 0.287 Aortic-related mortality 0(0) 0(0) 0(0) 0(0) / Retrograde type A dissection 1(1.9) 0(0) 1(2.7) 0(0) 0.520 Aortic-related reoperation 1(1.9) 0(0) 1(2.7) 0(0) 0.520 BTAI, blunt traumatic aortic injury; TEVAR, thoracic endovascular aortic repair; CTA, computed tomography angiography All data are presented as number (%). 4. Discussion BTAI is a rare but highly lethal condition. With improved imaging technology, the diagnostic rate of BTAI increased by 196.8% from 2003 to 2013 [ 12 ] . Although BTAI and acute aortic syndrome are both classified as acute aortic injuries, they differ significantly in etiology and management. Previous studies have identified motor vehicle collisions as the leading cause of BTAI, followed by falls from heights, pedestrian-vehicle collisions, and crush injuries [ 13 ] . In our study, motor vehicle accidents accounted for 60.7% of cases, and the prevalence of pre-existing comorbidities was relatively low: hypertension was present in 37.5%, coronary artery disease in 1.8%, and no patients had a history of cerebral infarction, which may explain the low perioperative cardiovascular complication rate. Another characteristic of BTAI patients is the high incidence of concomitant injuries to other organs. In our study, fractures (94.6%), pulmonary injuries (64.3%), and cranial injuries (41.1%) were most commonly observed, often accompanied by pleural effusions or pericardial effusions, in severe cases, coma. These findings are consistent with previous literature [ 14 , 15 ] . The decision to perform surgical intervention for associated injuries should be individualized. About one-third of patients required surgical management for these associated injuries, while others were treated conservatively. Additionally, BTAI patients frequently presented with elevated admission blood pressure, resembling patterns seen in acute aortic syndrome. This highlights the importance of controlling hemodynamics, with some studies recommending a target systolic blood pressure of 100–120 mmHg, a mean arterial pressure around 80 mmHg, and a heart rate of 60–80 beats per minute [ 5 , 16 – 18 ] . However, it is important to recognize that BTAI patients presenting with elevated ISS scores, hypotension, or SI > 1 typically indicate a severe condition necessitating urgent surgical intervention. TEVAR has replaced open repair as the preferred treatment for anatomically suitable Grade III BTAI patients due to its minimal invasiveness and favorable outcomes [ 19 ] . However, the optimal timing of TEVAR remains controversial. Historically, early TEVAR within 24 hours was the standard recommendation [ 5 ] , but recent evidence supports delayed TEVAR in BTAI patients with severe concomitant injuries. The 2015 Eastern Association for the Surgery of Trauma guidelines recommend delayed TEVAR for such patients, while early TEVAR remains an option for stable Grade III BTAI patients [ 6 ] . Over time, statistical analysis by Romijn [ 9 ] of 1,339 patients showed a higher mortality rate with early TEVAR ( p = 0.028 ), and meta-analysis by Marcaccio [ 8 ] of 507 patients found a statistically significant difference in mortality rates between early (11.9%) and delayed TEVAR (5.4%) ( p = 0.047 ). Increasing clinical evidence also suggests lower mortality rates with delayed TEVAR [ 7 , 20 – 22 ] . As evidence accumulates, the optimal surgical timing for BTAI patients becomes uncertain. Major international guidelines have yet to define the optimal timing for surgery [ 3 , 10 , 23 ] , particularly for stable Grade III BTAI, emphasizing the need for further research. In our cohort, early and delayed TEVAR groups had comparable baseline characteristics. Mortality, complication rates, and aortic-related outcomes did not differ significantly, although one death occurred in the early group due to shock—not aortic pathology. These findings suggest that delayed TEVAR is as safe and effective as early TEVAR for Grade III BTAI patients. However, Delayed TEVAR had a longer aortic-related hospital stay but similar total length of stay and ICU duration. This supports the safety of delayed TEVAR in stable patients. Notably, all 5 patients with SI > 1 underwent early TEVAR due to shock and aortic-related concerns, one of them died from uncorrectable shock acidosis, while the remaining patients recovered and were discharged. Additionally, a higher proportion of patients in the early TEVAR group required additional surgeries post-TEVAR (50.0% vs 10.8%, p = 0.006 ), likely due to concurrent injuries requiring urgent treatment. Conversely, delayed TEVAR was successfully performed in patients with coma or need for emergency surgery, without increasing complications. This supports the use of delayed TEVAR in complex trauma scenarios when the aorta is not the primary concern. Importantly, we found that 75% (27/36) of patients in the delayed TEVAR group were stable and achieved good outcomes, supporting the safety and efficiency of delayed TEVAR in this population. Currently, there are no recommendations for the specific timing of delayed TEVAR, and there is limited clinical evidence. In our center, 94.6% (35/37) of delayed cases were treated during the acute (< 14 days) or subacute (14–90 days) phase, with no significant differences in perioperative clinical outcomes between the two groups. The specific timing of delayed TEVAR, the effectiveness and safety of arch branch reconstruction in Grade III BTAI patients, and the role of conservative treatment in Grade III BTAI require further exploration. Our management protocol (Fig. 3 ) involves immediate hemodynamic assessment and whole-body CTA upon admission, followed by individualized treatment based on the primary life-threatening injury. For patients with predominant aortic injury, TEVAR timing was guided by hemodynamic stability. For those with primary non-aortic trauma, stabilization and urgent surgery took precedence, with TEVAR performed subsequently. Conservative treatment was rare; two of three such patients died within 24 hours, both with SI > 1, suggesting poor prognosis in unstable patients and supporting early intervention when hemodynamically compromised. Conversely, if the shock is unrelated to the aorta, other etiologies should be promptly investigated to avoid delayed diagnosis and potential mortality. Furthermore, research by Fortuna [ 24 ] indicates that Grade III and IV BTAI are associated with a high risk of aortic rupture, and non-surgical management of Grade III BTAI as an independent risk factor for mortality. Nonetheless, some studies have demonstrated the safety of conservative management in Grade III BTAI [ 25 ] . The therapeutic efficacy of conservative treatment in Grade III BTAI patients warrants further clinical investigation and validation. Anatomically, in our study, the aortic isthmus was the most common site of BTAI (85.7%). Clinically, this is significant as many patients may involve the left subclavian artery (LSA) or the left common carotid artery (LCCA), or may require reconstruction of the supra-aortic branches to extend the landing zone. At our center, the reconstruction was as high as 24.5% (13/53), and no ischemic complications or stent occlusions occurred, suggesting safety and feasibility. A study by DuBose reported stent migration in 3% and endoleak in 2% of patients undergoing TEVAR [ 26 ] . In our study, endoleak incidence was low (3.6%), with both cases resolving spontaneously. Concerns about intraoperative anticoagulation in trauma settings remain, but our results—like previous study [ 27 ] —demonstrated no bleeding complications with full-dose heparin. This supports its safe use during TEVAR, even in patients with polytrauma. However, our study is limited by its retrospective, single-center design and small sample size. Larger prospective studies are needed to refine indications for delayed TEVAR, assess supra-aortic branch reconstruction, and define the role of conservative treatment in selected patients. 5. Conclusion Grade III blunt traumatic aortic injury (BTAI) exhibits unique characteristics in its etiology, comorbidities, associated injuries, and prevalent injury sites. Delayed TEVAR and early TEVAR demonstrate comparable safety and efficacy for Grade III BTAI. In clinical practice, the choice between early TEVAR and delayed TEVAR should be based on individual patient factors. Abbreviations BTAI blunt trauma aortic injury TEVAR thoracic endovascular aortic repair ISS intensive severe scores SVS society for vascular surgery CTA computed tomography angiography BP blood pressure SI shock index ICU intensive care unit SD standard deviation LSA left subclavian artery LCCA left common carotid artery Declarations Acknowledgements Not applicable. Consent for publications Not applicable. Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This retrospective study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Second Xiangya hospital of Central South University. Competing interests The authors declare that they have no competing interests. Funding This study was supported by National Natural Science Foundation of China(82120108005 ， 81900423), Natural Science Foundation of Hunan Province of China(S2023JJMSXM2823), Scientific Research Program of Hunan Province Health and Wellness Commission(202204023157). Author’s contributions Conception and design: All authors. Collection and assembly of data: QQ, LCW. Data analysis and interpretation: QQ, LCW, QML, ML, HH, XL. Manuscript writing: QQ, LCW. Final approval of manuscript: All authors. References Piffaretti G, Williams IM, Bailey DM, Bashir M. Thoracic endovascular repair in patients with concomitant blunt aortic injuries and abdominal trauma: what are the risks and results? Eur J Cardiothorac Surg. 2022;62(6):ezac53. Zeng W, Caudillo A, Mukherjee S, Lee SH, Panzer MB. Development and multi-level validation of a computational model to predict traumatic aortic injury. Comput Biol Med. 2021;136:104700. Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):e334–482. Azizzadeh A, Keyhani K, Miller CC 3rd, Coogan SM, Safi HJ, Estrera AL. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg. 2009;49(6):1403–8. Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg. 2011;53(1):187–92. Fox N, Schwartz D, Salazar JH, et al. Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;78(1):136–46. Lozano R, DiLosa K, Schneck M, et al. Comparison of treatment and outcomes in blunt thoracic aortic injury based on different vascular surgery guidelines. J Vasc Surg. 2023;78(1):48–52. Marcaccio CL, Dumas RP, Huang Y, Yang W, Wang GJ, Holena DN. Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury. J Vasc Surg. 2018;68(1):64–73. Romijn AC, Rastogi V, Proaño-Zamudio JA, et al. Early Versus Delayed Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury: A Propensity Score-Matched Analysis. Ann Surg. 2023;278(4):e848–54. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873–926. the Committee of Great Vessels of Chinese Association of Cardiovascular Surgeons. Chinese experts' consensus of standardized diagnosis and treatment for aortic dissection. Chin J Thorac Cardiovasc Surg. 2017;33(11):641–54. Scalea TM, Feliciano DV, DuBose JJ, Ottochian M, O'Connor JV, Morrison JJ. Blunt Thoracic Aortic Injury: Endovascular Repair Is Now the Standard. J Am Coll Surg. 2019;228(4):605–10. Steenburg SD, Ravenel JG, Ikonomidis JS, Schönholz C, Reeves S. Acute traumatic aortic injury: imaging evaluation and management. Radiology. 2008;248(3):748–62. Yu L, Baumann BM, Raja AS, et al. Blunt Traumatic Aortic Injury in the Pan-scan Era. Acad Emerg Med. 2020;27(4):291–6. Boutin L, Caballero MJ, Guarrigue D, et al. Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort. Eur J Vasc Endovasc Surg. 2022;63(3):401–9. Trust MD, Teixeira PGR. Blunt Trauma of the Aorta, Current Guidelines. Cardiol Clin. 2017;35(3):441–51. Rabin J, DuBose J, Sliker CW, O'Connor JV, Scalea TM, Griffith BP. Parameters for successful nonoperative management of traumatic aortic injury. J Thorac Cardiovasc Surg. 2014;147(1):143–9. Mosquera VX, Marini M, Lopez-Perez JM, et al. Role of conservative management in traumatic aortic injury: comparison of long-term results of conservative, surgical, and endovascular treatment. J Thorac Cardiovasc Surg. 2011;142(3):614–21. Sun J, Ren K, Zhang L, et al. Traumatic blunt thoracic aortic injury: a 10-year single-center retrospective analysis. J Cardiothorac Surg. 2022;17(1):335. Li L, Lin LY, Lu YQ. Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience. World J Emerg Med. 2022;13(5):361–6. Alarhayem AQ, Rasmussen TE, Farivar B, et al. Timing of repair of blunt thoracic aortic injuries in the thoracic endovascular aortic repair era. J Vasc Surg. 2021;73(3):896–902. Smeds MR, Wright MP, Eidt JF, et al. Delayed management of Grade III blunt aortic injury: Series from a Level I trauma center. J Trauma Acute Care Surg. 2016;80(6):947–51. Members ATF, Czerny M, Grabenwöger M, et al. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg. 2024;118(1):5–115. Fortuna GR Jr, Perlick A, DuBose JJ, et al. Injury grade is a predictor of aortic-related death among patients with blunt thoracic aortic injury. J Vasc Surg. 2016;63(5):1225–31. Ye JB, Lee JY, Lee JS, et al. Observational management of Grade II or higher blunt traumatic thoracic aortic injury: 15 years of experience at a single suburban institution. Int J Crit Illn Inj Sci. 2022;12(2):101–5. DuBose JJ, Leake SS, Brenner M, et al. Contemporary management and outcomes of blunt thoracic aortic injury: a multicenter retrospective study. J Trauma Acute Care Surg. 2015;78(2):360–9. Kenel-Pierre S, Ramos Duran E, Abi-Chaker A, et al. The role of heparin in endovascular repair of blunt thoracic aortic injury. J Vasc Surg. 2019;70(6):1809–15. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6744825","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463833143,"identity":"8134f193-845d-41bd-bc8f-ac7866bbec80","order_by":0,"name":"Qi Qin","email":"","orcid":"","institution":"Second Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Qin","suffix":""},{"id":463833144,"identity":"9e91cd44-3c84-41bb-9065-0f4c3d62cf22","order_by":1,"name":"Lun-Chang Wang","email":"","orcid":"","institution":"Second Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Lun-Chang","middleName":"","lastName":"Wang","suffix":""},{"id":463833145,"identity":"729fc955-01cc-4303-8d7b-ce5d8ca4a348","order_by":2,"name":"Quan-Ming Li","email":"","orcid":"","institution":"Second Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Quan-Ming","middleName":"","lastName":"Li","suffix":""},{"id":463833146,"identity":"647e3ab0-5501-4981-aaff-2697ccb844da","order_by":3,"name":"Ming Li","email":"","orcid":"","institution":"Second Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Ming","middleName":"","lastName":"Li","suffix":""},{"id":463833147,"identity":"469fa5a5-f71c-4551-b314-844057f8e819","order_by":4,"name":"Hao He","email":"","orcid":"","institution":"Second Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"He","suffix":""},{"id":463833148,"identity":"16d027da-0d28-4a40-a83f-3b39c69a1c6d","order_by":5,"name":"Xin Li","email":"","orcid":"","institution":"Second Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Li","suffix":""},{"id":463833149,"identity":"6a119d35-e13e-45eb-9bd1-4a2a75a639ea","order_by":6,"name":"Chang Shu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDACCQYGZhDND+Eyk6BFsoFkLQYHiNUiP7vH8HNBzR27zcePP5NgqLBObGA/ewCvFoM7Z4ylZxx7lrztTI6ZBMOZ9MQGnrwE/FokcsyYedgOJ5vd4GGTYGw7nNggwWOA32EzQFr+HU42nsH+TILxHxFaGG4AtfC2HbYzkGAwk2BsIEKLwY20YmnevsMJEmdyjC0SjqUbt/HkEHJY8sbPPN8O2/O3H39440ONtWw/+xkCDoOCxAYQmQDEbESpBwJ7YhWOglEwCkbBCAQAI/xAJ3q5W3QAAAAASUVORK5CYII=","orcid":"","institution":"Second Xiangya Hospital of Central South University","correspondingAuthor":true,"prefix":"","firstName":"Chang","middleName":"","lastName":"Shu","suffix":""}],"badges":[],"createdAt":"2025-05-25 16:23:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6744825/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6744825/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83816034,"identity":"6ccd61c9-ff23-4db9-8cde-fe3638a04cdb","added_by":"auto","created_at":"2025-06-03 07:45:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":202352,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study patients selection.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6744825/v1/1c268035d08fe5fdbb07fcfb.png"},{"id":83816030,"identity":"1d7e6bd9-950d-4828-bc9a-8f97e26fcf85","added_by":"auto","created_at":"2025-06-03 07:44:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":3601231,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of preoperative and postoperative CTA results between the early TEVAR group and the delayed TEVAR group. (A-D) Early TEVAR group, (E-H) Delayed TEVAR group.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6744825/v1/9b82384e62afe78d9639c4ef.png"},{"id":83816033,"identity":"c8e0e344-2055-4e3b-a7af-37f9f1ecce92","added_by":"auto","created_at":"2025-06-03 07:44:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":259633,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of preoperative and postoperative CTA results between the early TEVAR group and the delayed TEVAR group. (A-D) Early TEVAR group, (E-H) Delayed TEVAR group.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6744825/v1/76524eb0b1d3ca42d34bff07.png"},{"id":86334111,"identity":"6962db85-9cc1-4239-a0bb-74c89f156563","added_by":"auto","created_at":"2025-07-09 12:53:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5476082,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6744825/v1/1e7833ca-474e-4842-a06d-6d92894d9db2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Delayed versus Early TEVAR in Grade III Blunt Traumatic Aortic Injury: A 12-Year Single-Center Retrospective Study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eBlunt traumatic aortic injury (BTAI) is a rare but life-threatening condition, most commonly tearing at the aortic isthmus. It is primarily caused by high-impact mechanisms such as motor vehicle collisions or falls from height. As the second leading cause of death in trauma patients, BTAI often presents alongside multiple injuries, making clinical diagnosis and management more complex\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The most widely adopted grading system for BTAI is based on imaging findings and stratifies injuries by severity: Grade I manifests as intimal tears, intimal flaps, or both; Grade II as intramural hematoma; Grade III as aortic wall disruption with pseudoaneurysm; and Grade IV as aortic wall disruption with free rupture\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Current guidelines recommend conservative management with serial imaging for Grade I-II injuries. Surgical intervention is advised for Grade II injuries complicated by a posterior mediastinal hematoma\u0026thinsp;\u0026gt;\u0026thinsp;10 mm or compressive hematoma, and is considered mandatory for Grades III-IV unless contraindicated\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThoracic endovascular aortic repair (TEVAR) has become the first-line surgical choice, but controversy persists regarding the optimal timing of TEVAR. Earlier guidelines suggested surgical repair within 24 hours of injury (early TEVAR) to reduce the risk of aortic rupture-related death\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. In recent years, increasing evidence has shown that delayed or elective TEVAR (performed more than 24 hours after injury) significantly reduces perioperative mortality compared to early TEVAR\u003csup\u003e[\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Current guidelines have not yet established a definitive consensus regarding the ideal timing for TEVAR, indicating the need for further clinical investigation\u0026mdash;particularly in cases of Grade III BTAI involving pseudoaneurysm.\u003c/p\u003e \u003cp\u003eThis study aimed to summarize 12 years of single-center experience and evaluate the safety and efficacy of early versus delayed TEVAR in patients with Grade III BTAI, providing further clinical insight into optimal surgical timing.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis retrospective study included patients with Grade III BTAI admitted to our center between August 2011 and January 2024. Grade III BTAI was defined as aortic wall disruption with pseudoaneurysm formation by the Society for Vascular Surgery (SVS) clinical practice guideline\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. The patient selection flowchart is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBaseline characteristics of patients, such as age, gender, trauma types, medical history, associated injuries, complications, Intensive severe scores (ISS) were obtained from medical records. Hemodynamic parameters including systolic and diastolic blood pressure (BP), heart rate, and shock index (SI) were recorded, with SI calculated as the ratio of heart rate to systolic blood pressure. Data on surgical details, mortality, postoperative complications such as endoleak, paraplegia, stroke, myocardial infraction, renal failure were collected. Hospitalization metrics included total length of hospital stay, length of hospital stay for aortic disease, and intensive care unit (ICU) stay durations. Post-discharge follow-up was conducted through outpatient clinic visits and telephone interviews. Outpatient follow-up included clinical symptoms, physical examinations, and aortic CTA, while telephone follow-up focused on the patient's health status, new aortic-related conditions, and whether a secondary surgery had been performed.\u003c/p\u003e \u003cp\u003eStatistical analysis was conducted using SPSS 26.0 software. Quantitative variables were described as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median (M) and compared using an independent sample t-test or non-parametric rank-sum test. Qualitative variables were described as frequencies (n) and proportions (%), and comparisons were made using the chi-squared (χ\u0026sup2;) test or non-parametric rank-sum test. A \u003cem\u003ep\u003c/em\u003e -value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1. General Characteristics of Patients\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on these 56 patients, with the majority whom were male (75%). The patients ranged in age from 19 to 80 years, with a mean age of 49.57\u0026thinsp;\u0026plusmn;\u0026thinsp;16.06 years. Patients under 40 years old accounted for 26.8% of the cohort. The main cause of trauma was car accidents (60.7%), followed by falls (25%) and other types of blunt trauma (14.3%). A history of cardiovascular disease was relatively uncommon in this population. Hypertension was present in 21 patients (37.5%), while only 1 patient (1.8%) had a history of coronary artery disease, and none had a history of cerebral infarction. Among the 56 patients with Grade III BTAI, 3 patients did not undergo surgical treatment and were categorized into the non-surgical group. The remaining 53 patients underwent TEVAR after admission. Based on the time interval from injury to surgery, 16 patients were included in the early TEVAR group (\u0026lt;\u0026thinsp;24h), and 37 patients were included in the delayed TEVAR group (\u0026gt;\u0026thinsp;24h). There were no statistically significant differences in the clinical characteristics between the early and delayed TEVAR groups. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients with grade III BTAI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll BTAI(n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEarly TEVAR(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDelayed TEVAR(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-surgical group(n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value (Comparison of early TEVAR \u003cem\u003evs.\u003c/em\u003e delayed TEVAR)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.57\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e16.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.31\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e15.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.19\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e15.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.00\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e26.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.295\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrauma types\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalling injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraffic accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.869\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebral Infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003eincluding blast injury, blunt force trauma\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBTAI, blunt traumatic aortic injury; TEVAR, thoracic endovascular aortic repair\u003c/p\u003e \u003cp\u003eAll data are presented as mean\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003estandard deviation or number (%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Clinical Presentations and Imaging Characteristics of Patients\u003c/h2\u003e \u003cp\u003eAll 56 patients sustained multiple traumatic injuries, with fractures (94.6%), lung injuries (64.3%), and cranial injuries (41.1%) being the most common. Renal (17.9%) and hepatic (10.7%) injuries were less frequent. Pleural effusion was observed in 46 cases (82.1%), including 6 cases (10.7%) with large-volume effusion, and pericardial effusion in 7 cases (12.5%). Four patients (7.1%) were admitted in a comatose state, including 3 cases (8.1%) in the delayed TEVAR group and 1 case (33.3%) in the non-surgical group. No cases of preoperative paraplegia were recorded. There were no statistically significant differences in clinical presentations between the early and delayed TEVAR groups. However, the ISS at admission averaged 30.57\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61 points across all patients, with significantly higher scores in the early TEVAR group compared to the delayed TEVAR group (32.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67 \u003cem\u003evs.\u003c/em\u003e 29.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.81, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/em\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFollowing initial stabilization at the trauma center, the systolic blood pressure on admission was 137.43\u0026thinsp;\u0026plusmn;\u0026thinsp;23.96 mmHg, diastolic blood pressure was 80.96\u0026thinsp;\u0026plusmn;\u0026thinsp;11.89 mmHg, and heart rate was 89.96\u0026thinsp;\u0026plusmn;\u0026thinsp;15.98 beats per minute. These findings suggest that while hypertension is not the primary cause of BTAI, most patients present with hypertensive crises upon arrival. The shock index (SI), calculated as heart rate divided by systolic pressure, exceeded 1.0 in 7 patients (12.5%). Among them, 5 cases (31.3%) were in the early TEVAR group and 2 cases (66.7%) in the non-surgical group. The proportion of SI\u0026thinsp;\u0026gt;\u0026thinsp;1 was significantly higher in the early TEVAR group than in the delayed group (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/em\u003e), suggesting that the timing of TEVAR should consider the patient's hemodynamic status, with early TEVAR recommended when hemodynamically unstable.\u003c/p\u003e \u003cp\u003eCTA imaging revealed the aortic isthmus as the rupture site in 48 cases (85.7%), consistent with typical BTAI patterns, with no significant difference in distribution between groups. No statistically significant differences were found in rupture site distribution between the early and delayed TEVAR groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Presentation and CTA Imaging Characteristics of Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll BTAI(n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEarly TEVAR(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDelayed TEVAR(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-surgical group(n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value (Comparison of early TEVAR \u003cem\u003evs.\u003c/em\u003e delayed TEVAR)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAssociated injuries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53(94.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(93.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(94.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung injuries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36(64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCranial injuries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal injuries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatic injuries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.602\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePleural effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(82.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(93.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(75.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elarge-volume effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePericardial effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.859\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative paraplegia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eISS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.57\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e5.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.56\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.19\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.00\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e14.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.004\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemodynamics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic BP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137.43\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e23.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133.63\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e29.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e139.95\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e19.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e126.67\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e40.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.367\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic BP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.96\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e11.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.19\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e11.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.14\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e11.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.33\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e12.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89.96\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e15.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.69\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e12.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.16\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e16.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110.00\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e13.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSI\u0026gt;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrimary intimal tear location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAortic isthmus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eincluding proximal descending aorta, ascending aorta, aortic arch, distal descending aorta.\u003c/p\u003e \u003cp\u003eBTAI, blunt traumatic aortic injury; TEVAR, thoracic endovascular aortic repair; ISS, injury severity score; BP, blood pressure; SI, shock index\u003c/p\u003e \u003cp\u003eAll data are presented as mean\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003estandard deviation or number (%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Treatment Strategies and Perioperative Outcomes\u003c/h2\u003e \u003cp\u003e According to early international guidelines, TEVAR is recommended within 24 hours for Grade III or higher BTAI. In our cohort, 16 patients received emergency early TEVAR within 24 hours after admission, mainly due to hemodynamic instability, progression of aortic injury on CTA, or the need for urgent surgery for associated injuries. In contrast, the 37 patients in the delayed TEVAR group were primarily admitted more than 24 hours post-trauma and were hemodynamically stable.\u003c/p\u003e \u003cp\u003eAll 53 patients who underwent TEVAR received general anesthesia and intraoperative heparin, with a 100% technical success rate. Emergency surgeries were performed in all 16 in the early TEVAR group (100%) while none in the delayed TEVAR group underwent emergency procedures, showing a statistically significant difference (\u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e). The mean surgical duration for all 53 patients was 1.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50 hours, with no significant difference between the early (1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51 hours) and delayed TEVAR groups(1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50 hours), suggesting comparable surgical complexity between the two groups. Arch branch reconstruction was performed in 12 patients (22.6%), with comparable rates in both groups, reflecting a higher rate of arch branch reconstruction related to the location of the injury predominantly at the aortic arch. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the comparison of preoperative and postoperative CTA results between the two groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePerioperative mortality was slightly higher in the early TEVAR group (6.3% \u003cem\u003evs\u003c/em\u003e 0%, \u003cem\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/em\u003e), with one death due to refractory acidosis following shock. No myocardial infarction, stroke, paraplegia or unplanned reintervention occurred in either group. Postoperative CTA follow-up revealed no endoleaks in the early TEVAR group, while two endoleaks (type II and IV) occurred in the delayed group (0% \u003cem\u003evs\u003c/em\u003e 5.4%, \u003cem\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/em\u003e), both resolved spontaneously. Among patients who underwent arch branch reconstruction in both groups, follow-up results indicated patency of the branch stents without ischemic complications. In the non-surgical group, one patient died from sudden cardiac arrest on the first day of conservative treatment due to economic limitations, while another patient died from cerebral herniation secondary to severe traumatic brain injury.\u003c/p\u003e \u003cp\u003eAortic-related hospital stay was significantly shorter in the early TEVAR group (9.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63 days \u003cem\u003evs\u003c/em\u003e 15.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85 days, \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e), possibly reflecting the greater need for secondary non-vascular surgeries in the early TEVAR group. However, the total length of hospital stay and ICU stay duration showed no significant difference (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTreatment Strategies and Perioperative Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll BTAI(n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eEarly TEVAR(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDelayed TEVAR(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical Details\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical success\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e53(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e16(30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\u0026lt;\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e53(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative use of heparin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e53(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery duration (hour)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.18\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.22\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.16\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLSA arch branch reconstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e12(22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLCCA stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain stents count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.32\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.44\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.27\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerioperative mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoleak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParaplegia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned reoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatency of the branch stents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e53(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital Stay Duration (day)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal length of hospital stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e20.00\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e11.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.25\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e15.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.03\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e10.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.535\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay for aortic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e13.83\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e6.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.13\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.95\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e5.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\u0026lt;\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU stay durations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.70\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e6.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.44\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e5.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.38\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e6.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBTAI, blunt traumatic aortic injury; TEVAR, thoracic endovascular aortic repair; LSA, left subclavian artery; LCCA, left common carotid artery; ICU, intensive unit care\u003c/p\u003e \u003cp\u003eAll data are presented as mean\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003estandard deviation or number (%).\u003c/p\u003e \u003cp\u003eTo further investigate the potential impact of varying delay times within the delayed TEVAR group on outcomes, there is currently no clear staging for BTAI. We referred to the 2014 ESC Aortic Disease Guidelines and the Chinese consensus on aortic dissection staging\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, dividing patients into three subgroups based on delayed days: \u0026lt;14 days (n\u0026thinsp;=\u0026thinsp;17), 14\u0026ndash;90 days (n\u0026thinsp;=\u0026thinsp;18), and \u0026gt;\u0026thinsp;90 days(n\u0026thinsp;=\u0026thinsp;2). Considering the limited sample size in \u0026gt;\u0026thinsp;90 days group, statistical analysis of the first two groups were performed and showed no significant difference in perioperative mortality or complication rates, suggesting that the acute-subacute transition period may not critically impact technical success, but prolonged delay was associated with significantly extended hospital stays (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubgroup analysis of Delayed TEVAR\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;14 days (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u0026ndash;90 days (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;90 days (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value (\u0026lt;\u0026thinsp;14 days \u003cem\u003evs.\u003c/em\u003e 14\u0026ndash;90 days)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerioperative mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoleak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParaplegia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital Stay Duration (day)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal length of hospital stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.24\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e10.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.33\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e10.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.50\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay for aortic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.71\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.17\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e7.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.50\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU stay durations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.82\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e6.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.33\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e6.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eICU, intensive care unit.\u003c/p\u003e \u003cp\u003eAll data are presented as mean\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003estandard deviation or number (%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Management of Associated Injuries and Follow-Up Results\u003c/h2\u003e \u003cp\u003eManagement of associated injuries represents a critical aspect of care in patients with BTAI. In our cohort, the overall surgical intervention rate for associated injuries was 32.1%. In the delayed TEVAR group, 6 patients underwent emergency surgeries before TEVAR, including cranial, abdominal, and orthopedic procedures. After TEVAR, 12 patients required additional surgeries, with a higher rate in the early TEVAR group (50.0% \u003cem\u003evs.\u003c/em\u003e 10.8%, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.006\u003c/em\u003e). This finding suggests a higher incidence of secondary surgical interventions for associated injuries post-TEVAR in the early TEVAR group.\u003c/p\u003e \u003cp\u003eSuccessful CTA follow-up was achieved in 49 patients (92.5%) with a median duration of 13.4 months, and telephone follow-up was successful in 41 patients (77.4%) with a median duration of 37 months. The survival rate was 100% in the early TEVAR group and 92.3% in the delayed group, with no aortic-related deaths. Two endoleaks in the delayed group resolved spontaneously, and one patient required open surgery for retrograde type A dissection. No reinterventions were required in the early TEVAR group. None of these differences reached statistical significance. One non-surgical patient remained alive at 3 years (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eManagement of Associated Injuries and Follow-up Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll BTAI(n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eEarly TEVAR9(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eDelayed TEVAR(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNon-surgical group(n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value (Comparison of early TEVAR \u003cem\u003evs.\u003c/em\u003e delayed TEVAR)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAssociated Injuries Surgeries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e18(32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e/\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore TEVAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6(11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e/\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCranial surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e/\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthopedic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e/\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExploratory laparotomy with visceral repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e/\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFracture and urethral repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e/\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter TEVAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e12(22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e/\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e0.006\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCranial surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthopedic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11(20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e/\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisceral surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up(Total 53)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelephone follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e41(77.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14(87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26(70.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian follow-up time(month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCTA follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e49(92.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14(93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34(91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian follow-up time(month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e39(97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24(92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAortic-related mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetrograde type A dissection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAortic-related reoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBTAI, blunt traumatic aortic injury; TEVAR, thoracic endovascular aortic repair; CTA, computed tomography angiography\u003c/p\u003e \u003cp\u003eAll data are presented as number (%).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eBTAI is a rare but highly lethal condition. With improved imaging technology, the diagnostic rate of BTAI increased by 196.8% from 2003 to 2013\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Although BTAI and acute aortic syndrome are both classified as acute aortic injuries, they differ significantly in etiology and management. Previous studies have identified motor vehicle collisions as the leading cause of BTAI, followed by falls from heights, pedestrian-vehicle collisions, and crush injuries\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. In our study, motor vehicle accidents accounted for 60.7% of cases, and the prevalence of pre-existing comorbidities was relatively low: hypertension was present in 37.5%, coronary artery disease in 1.8%, and no patients had a history of cerebral infarction, which may explain the low perioperative cardiovascular complication rate.\u003c/p\u003e \u003cp\u003eAnother characteristic of BTAI patients is the high incidence of concomitant injuries to other organs. In our study, fractures (94.6%), pulmonary injuries (64.3%), and cranial injuries (41.1%) were most commonly observed, often accompanied by pleural effusions or pericardial effusions, in severe cases, coma. These findings are consistent with previous literature\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe decision to perform surgical intervention for associated injuries should be individualized. About one-third of patients required surgical management for these associated injuries, while others were treated conservatively. Additionally, BTAI patients frequently presented with elevated admission blood pressure, resembling patterns seen in acute aortic syndrome. This highlights the importance of controlling hemodynamics, with some studies recommending a target systolic blood pressure of 100\u0026ndash;120 mmHg, a mean arterial pressure around 80 mmHg, and a heart rate of 60\u0026ndash;80 beats per minute\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. However, it is important to recognize that BTAI patients presenting with elevated ISS scores, hypotension, or SI\u0026thinsp;\u0026gt;\u0026thinsp;1 typically indicate a severe condition necessitating urgent surgical intervention.\u003c/p\u003e \u003cp\u003eTEVAR has replaced open repair as the preferred treatment for anatomically suitable Grade III BTAI patients due to its minimal invasiveness and favorable outcomes\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. However, the optimal timing of TEVAR remains controversial. Historically, early TEVAR within 24 hours was the standard recommendation\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, but recent evidence supports delayed TEVAR in BTAI patients with severe concomitant injuries. The 2015 Eastern Association for the Surgery of Trauma guidelines recommend delayed TEVAR for such patients, while early TEVAR remains an option for stable Grade III BTAI patients\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Over time, statistical analysis by Romijn\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e of 1,339 patients showed a higher mortality rate with early TEVAR (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.028\u003c/em\u003e), and meta-analysis by Marcaccio\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e of 507 patients found a statistically significant difference in mortality rates between early (11.9%) and delayed TEVAR (5.4%) (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.047\u003c/em\u003e). Increasing clinical evidence also suggests lower mortality rates with delayed TEVAR\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. As evidence accumulates, the optimal surgical timing for BTAI patients becomes uncertain. Major international guidelines have yet to define the optimal timing for surgery\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, particularly for stable Grade III BTAI, emphasizing the need for further research.\u003c/p\u003e \u003cp\u003eIn our cohort, early and delayed TEVAR groups had comparable baseline characteristics. Mortality, complication rates, and aortic-related outcomes did not differ significantly, although one death occurred in the early group due to shock\u0026mdash;not aortic pathology. These findings suggest that delayed TEVAR is as safe and effective as early TEVAR for Grade III BTAI patients. However, Delayed TEVAR had a longer aortic-related hospital stay but similar total length of stay and ICU duration. This supports the safety of delayed TEVAR in stable patients.\u003c/p\u003e \u003cp\u003eNotably, all 5 patients with SI\u0026thinsp;\u0026gt;\u0026thinsp;1 underwent early TEVAR due to shock and aortic-related concerns, one of them died from uncorrectable shock acidosis, while the remaining patients recovered and were discharged. Additionally, a higher proportion of patients in the early TEVAR group required additional surgeries post-TEVAR (50.0% \u003cem\u003evs\u003c/em\u003e 10.8%, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.006\u003c/em\u003e), likely due to concurrent injuries requiring urgent treatment. Conversely, delayed TEVAR was successfully performed in patients with coma or need for emergency surgery, without increasing complications. This supports the use of delayed TEVAR in complex trauma scenarios when the aorta is not the primary concern. Importantly, we found that 75% (27/36) of patients in the delayed TEVAR group were stable and achieved good outcomes, supporting the safety and efficiency of delayed TEVAR in this population. Currently, there are no recommendations for the specific timing of delayed TEVAR, and there is limited clinical evidence. In our center, 94.6% (35/37) of delayed cases were treated during the acute (\u0026lt;\u0026thinsp;14 days) or subacute (14\u0026ndash;90 days) phase, with no significant differences in perioperative clinical outcomes between the two groups. The specific timing of delayed TEVAR, the effectiveness and safety of arch branch reconstruction in Grade III BTAI patients, and the role of conservative treatment in Grade III BTAI require further exploration.\u003c/p\u003e \u003cp\u003eOur management protocol (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) involves immediate hemodynamic assessment and whole-body CTA upon admission, followed by individualized treatment based on the primary life-threatening injury. For patients with predominant aortic injury, TEVAR timing was guided by hemodynamic stability. For those with primary non-aortic trauma, stabilization and urgent surgery took precedence, with TEVAR performed subsequently.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eConservative treatment was rare; two of three such patients died within 24 hours, both with SI\u0026thinsp;\u0026gt;\u0026thinsp;1, suggesting poor prognosis in unstable patients and supporting early intervention when hemodynamically compromised. Conversely, if the shock is unrelated to the aorta, other etiologies should be promptly investigated to avoid delayed diagnosis and potential mortality. Furthermore, research by Fortuna\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e indicates that Grade III and IV BTAI are associated with a high risk of aortic rupture, and non-surgical management of Grade III BTAI as an independent risk factor for mortality. Nonetheless, some studies have demonstrated the safety of conservative management in Grade III BTAI\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. The therapeutic efficacy of conservative treatment in Grade III BTAI patients warrants further clinical investigation and validation.\u003c/p\u003e \u003cp\u003eAnatomically, in our study, the aortic isthmus was the most common site of BTAI (85.7%). Clinically, this is significant as many patients may involve the left subclavian artery (LSA) or the left common carotid artery (LCCA), or may require reconstruction of the supra-aortic branches to extend the landing zone. At our center, the reconstruction was as high as 24.5% (13/53), and no ischemic complications or stent occlusions occurred, suggesting safety and feasibility. A study by DuBose reported stent migration in 3% and endoleak in 2% of patients undergoing TEVAR\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. In our study, endoleak incidence was low (3.6%), with both cases resolving spontaneously. Concerns about intraoperative anticoagulation in trauma settings remain, but our results\u0026mdash;like previous study\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e\u0026mdash;demonstrated no bleeding complications with full-dose heparin. This supports its safe use during TEVAR, even in patients with polytrauma.\u003c/p\u003e \u003cp\u003eHowever, our study is limited by its retrospective, single-center design and small sample size. Larger prospective studies are needed to refine indications for delayed TEVAR, assess supra-aortic branch reconstruction, and define the role of conservative treatment in selected patients.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eGrade III blunt traumatic aortic injury (BTAI) exhibits unique characteristics in its etiology, comorbidities, associated injuries, and prevalent injury sites. Delayed TEVAR and early TEVAR demonstrate comparable safety and efficacy for Grade III BTAI. In clinical practice, the choice between early TEVAR and delayed TEVAR should be based on individual patient factors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBTAI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eblunt trauma aortic injury\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTEVAR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ethoracic endovascular aortic repair\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eISS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eintensive severe scores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSVS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003esociety for vascular surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCTA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ecomputed tomography angiography\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eblood pressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eshock index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eintensive care unit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003estandard deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLSA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eleft subclavian artery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLCCA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eleft common carotid artery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot applicable.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot applicable.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThis retrospective study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Second Xiangya hospital of Central South University.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe authors declare that they have no competing interests.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThis study was supported by National Natural Science Foundation of China(82120108005\u003c/strong\u003e\u003cstrong\u003e，\u003c/strong\u003e\u003cstrong\u003e81900423), Natural Science Foundation of Hunan Province of China(S2023JJMSXM2823), Scientific Research Program of Hunan Province Health and Wellness Commission(202204023157).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConception and design: All authors.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCollection and assembly of data: QQ, LCW.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis and interpretation: QQ, LCW, QML, ML, HH, XL.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManuscript writing: QQ, LCW.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinal approval of manuscript: All authors.\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePiffaretti G, Williams IM, Bailey DM, Bashir M. Thoracic endovascular repair in patients with concomitant blunt aortic injuries and abdominal trauma: what are the risks and results? Eur J Cardiothorac Surg. 2022;62(6):ezac53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeng W, Caudillo A, Mukherjee S, Lee SH, Panzer MB. Development and multi-level validation of a computational model to predict traumatic aortic injury. Comput Biol Med. 2021;136:104700.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):e334\u0026ndash;482.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzizzadeh A, Keyhani K, Miller CC 3rd, Coogan SM, Safi HJ, Estrera AL. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg. 2009;49(6):1403\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg. 2011;53(1):187\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFox N, Schwartz D, Salazar JH, et al. Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;78(1):136\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLozano R, DiLosa K, Schneck M, et al. Comparison of treatment and outcomes in blunt thoracic aortic injury based on different vascular surgery guidelines. J Vasc Surg. 2023;78(1):48\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarcaccio CL, Dumas RP, Huang Y, Yang W, Wang GJ, Holena DN. Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury. J Vasc Surg. 2018;68(1):64\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomijn AC, Rastogi V, Proa\u0026ntilde;o-Zamudio JA, et al. Early Versus Delayed Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury: A Propensity Score-Matched Analysis. Ann Surg. 2023;278(4):e848\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873\u0026ndash;926.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ethe Committee of Great Vessels of Chinese Association of Cardiovascular Surgeons. Chinese experts' consensus of standardized diagnosis and treatment for aortic dissection. Chin J Thorac Cardiovasc Surg. 2017;33(11):641\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScalea TM, Feliciano DV, DuBose JJ, Ottochian M, O'Connor JV, Morrison JJ. Blunt Thoracic Aortic Injury: Endovascular Repair Is Now the Standard. J Am Coll Surg. 2019;228(4):605\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteenburg SD, Ravenel JG, Ikonomidis JS, Sch\u0026ouml;nholz C, Reeves S. Acute traumatic aortic injury: imaging evaluation and management. Radiology. 2008;248(3):748\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu L, Baumann BM, Raja AS, et al. Blunt Traumatic Aortic Injury in the Pan-scan Era. Acad Emerg Med. 2020;27(4):291\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoutin L, Caballero MJ, Guarrigue D, et al. Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort. Eur J Vasc Endovasc Surg. 2022;63(3):401\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrust MD, Teixeira PGR. Blunt Trauma of the Aorta, Current Guidelines. Cardiol Clin. 2017;35(3):441\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRabin J, DuBose J, Sliker CW, O'Connor JV, Scalea TM, Griffith BP. Parameters for successful nonoperative management of traumatic aortic injury. J Thorac Cardiovasc Surg. 2014;147(1):143\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMosquera VX, Marini M, Lopez-Perez JM, et al. Role of conservative management in traumatic aortic injury: comparison of long-term results of conservative, surgical, and endovascular treatment. J Thorac Cardiovasc Surg. 2011;142(3):614\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun J, Ren K, Zhang L, et al. Traumatic blunt thoracic aortic injury: a 10-year single-center retrospective analysis. J Cardiothorac Surg. 2022;17(1):335.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi L, Lin LY, Lu YQ. Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience. World J Emerg Med. 2022;13(5):361\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlarhayem AQ, Rasmussen TE, Farivar B, et al. Timing of repair of blunt thoracic aortic injuries in the thoracic endovascular aortic repair era. J Vasc Surg. 2021;73(3):896\u0026ndash;902.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmeds MR, Wright MP, Eidt JF, et al. Delayed management of Grade III blunt aortic injury: Series from a Level I trauma center. J Trauma Acute Care Surg. 2016;80(6):947\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMembers ATF, Czerny M, Grabenw\u0026ouml;ger M, et al. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg. 2024;118(1):5\u0026ndash;115.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFortuna GR Jr, Perlick A, DuBose JJ, et al. Injury grade is a predictor of aortic-related death among patients with blunt thoracic aortic injury. J Vasc Surg. 2016;63(5):1225\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYe JB, Lee JY, Lee JS, et al. Observational management of Grade II or higher blunt traumatic thoracic aortic injury: 15 years of experience at a single suburban institution. Int J Crit Illn Inj Sci. 2022;12(2):101\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuBose JJ, Leake SS, Brenner M, et al. Contemporary management and outcomes of blunt thoracic aortic injury: a multicenter retrospective study. J Trauma Acute Care Surg. 2015;78(2):360\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKenel-Pierre S, Ramos Duran E, Abi-Chaker A, et al. The role of heparin in endovascular repair of blunt thoracic aortic injury. J Vasc Surg. 2019;70(6):1809\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Blunt traumatic aortic injury, Thoracic endovascular aortic repair, Surgical timing","lastPublishedDoi":"10.21203/rs.3.rs-6744825/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6744825/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThis 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA 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 (\u0026lt;24h), delayed TEVAR (\u0026gt;24h), or conservative management. Perioperative and follow-up outcomes were assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong 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 \u0026gt;1, and emergency surgery rates (all p\u0026lt;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\u0026lt;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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eDelayed 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.\u003c/p\u003e","manuscriptTitle":"Delayed versus Early TEVAR in Grade III Blunt Traumatic Aortic Injury: A 12-Year Single-Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-03 07:44:51","doi":"10.21203/rs.3.rs-6744825/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1b175a37-650c-441d-b29b-47a1b3b06cc3","owner":[],"postedDate":"June 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-14T23:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-03 07:44:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6744825","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6744825","identity":"rs-6744825","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}