Hemodynamic-Driven Vessel Diameter Changes and Stent-Graft Sizing in Vascular Injuries.

PURPOSE: To evaluate vessel diameter (VD) changes in vascular injuries (VI) by comparing pre- and post-procedural CT scans after endovascular repair with covered stents (CS), and to assess the relationship between stent oversizing and early complications. MATERIALS AND METHODS: This retrospective single-center study included consecutive patients treated with CS for VI between 2019 and 2025. VD was measured on pre-procedural and early post-procedural (≤2 weeks) CT scans at standardized proximal and distal landing zones. Patients were stratified by vessel size (large ≥1 cm, including the aorta; small-to-medium <1 cm), hemodynamic status, age, and sex. Stent oversizing was defined as the percentage difference between the nominal stent diameter and the mean proximal vessel diameter on pre-procedural CT. Stent-related complications were recorded. RESULTS: One hundred patients (mean age 65 ± 16 years; 70% male) were included; 57% had large-vessel injuries and 43% were hemodynamically unstable. Post-procedural VD increased significantly in small-to-medium vessels in both stable (26.0%, p=0.035) and unstable patients (62.9%, p=0.002), and in unstable large vessels (13.5%, p=0.04). Greater VD changes were observed in males younger than 70 years (p=0.035). Mean stent oversizing was 21% in small-to-medium vessels and 17% in large vessels, with a non-significant trend toward higher values in unstable small-to-medium vessels. Early stent-related complications occurred in 8% of patients, with no significant association detected with oversizing. CONCLUSION: VI showed marked, hemodynamically driven VD changes, particularly in small-to-medium vessels. No significant association was detected between moderate stent oversizing (∼20%) and early complications, though this finding warrants cautious interpretation given the small number of events and incomplete follow-up.