Journal of Vascular Surgery
Volume 46, Issue 5 , Pages 934-940, November 2007

Outcomes of surgical and endovascular treatment of acute traumatic thoracic aortic injury

Presented at the Thirty-first Annual Meeting of the Southern Association for Vascular Surgery, Rio Grande, Puerto Rico, January 17-20, 2006.

  • Paul J. Riesenman, MD, MS

      Affiliations

    • Department of Surgery, Division of Vascular Surgery, University of North Carolina Hospitals, Chapel Hill, NC
    • ,
  • Mark A. Farber, MD

      Affiliations

    • Department of Surgery, Division of Vascular Surgery, University of North Carolina Hospitals, Chapel Hill, NC
    • Corresponding Author InformationReprint requests: Mark A. Farber, MD, Associate Professor, Division of Vascular Surgery, University of North Carolina, CB#7212, 3024 Burnett-Womack Building, Chapel Hill, NC, 27599-7212.
    • ,
  • Preston B. Rich, MD

      Affiliations

    • Division of Trauma, Critical Care, Burns, University of North Carolina Hospitals, Chapel Hill, NC
    • ,
  • Brett C. Sheridan, MD

      Affiliations

    • Division of Cardiothoracic Surgery, University of North Carolina Hospitals, Chapel Hill, NC.
    • ,
  • Robert R. Mendes, MD

      Affiliations

    • Department of Surgery, Division of Vascular Surgery, University of North Carolina Hospitals, Chapel Hill, NC
    • ,
  • William A. Marston, MD

      Affiliations

    • Department of Surgery, Division of Vascular Surgery, University of North Carolina Hospitals, Chapel Hill, NC
    • ,
  • Blair A. Keagy, MD

      Affiliations

    • Department of Surgery, Division of Vascular Surgery, University of North Carolina Hospitals, Chapel Hill, NC

Received 6 March 2007; accepted 17 July 2007.

Background

Acute thoracic aortic injury resulting from blunt trauma is a life-threatening condition. Endovascular therapy is a less invasive treatment modality that may potentially improve patient outcomes. We reviewed our experience with patients who sustained blunt thoracic aortic injuries distal to the left subclavian artery and presented for open surgical or endovascular repair.

Methods

Between August 1993 and August 2006, 62 patients sustained blunt thoracic aortic injuries distal to the origin of the left subclavian artery and proceeded to undergo open surgical (n = 48, 77%), or endovascular repair (n = 14, 23%). Revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS), individual associated traumatic injuries, as well as operative and postoperative outcomes were compared between open surgical and endovascular groups.

Results

Age, gender, race, and mechanism of injury did not differ between open surgical and endovascular groups. Additionally, RTS, ISS, and NISS values were not significantly different. The proportion of patients with sternal fractures (14% vs 0%), or unstable spinal fractures (36% vs 10%) was significantly greater in the endovascular group. Of the patients who received endografts, 93% (n = 13) were evaluated by a cardiothoracic surgeon and assessed to be prohibitive to operative intervention. Endografts utilized included commercially manufactured thoracic endografts (n = 6; 43%) and abdominal aortic endograft components (n = 8; 57%). Forty-one interposition grafts were placed in the open surgical group. Renal complications (32% vs 7%), and urinary tract infections (35% vs 7%) approached significance between surgical and endovascular groups (P = .082 and P = .077, respectively). Intraoperative mortality for the surgical and endovascular groups was 23% and 0%, respectively (P = .056). Endovascular repair was associated with significant reductions in operative time (118 vs 209 minutes), estimated blood loss (77 vs 3180 ml), and intraoperative blood transfusions (0.9 vs 6.1 units). No endoleaks were detected during a mean follow-up of 9.4 months in the endovascular group.

Conclusion

Endovascular repair of blunt descending thoracic aortic injuries utilizing thoracic or abdominal endographs is a technically feasible modality that is at least equivalent to open therapy in the short term and associated with a lower intraoperative mortality (P = .056). Endovascular therapy has advantages in operative time, operative blood loss, and intraoperative blood transfusions.

 

 Competition of interest: Mark A. Farber is a consultant for Cook Inc, W. L. Gore & Associates, Inc, and Medtronic, Inc.

PII: S0741-5214(07)01191-3

doi:10.1016/j.jvs.2007.07.029

Journal of Vascular Surgery
Volume 46, Issue 5 , Pages 934-940, November 2007

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