Document Detail


Blunt thoracic aortic injury: open or stent graft repair?
MedLine Citation:
PMID:  18847641     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite a lack of level I evidence, endovascular stent grafting is frequently used for the treatment of blunt thoracic aortic injury. The purpose of this study is to compare the outcomes between open and endovascular repair of traumatic rupture of the thoracic aorta. METHODS: This article is based on a single-institution review of all consecutive patients treated for blunt aortic injury at the University of Wisconsin Hospital and Clinics between October 1999 and May 2007. This study was reviewed and approved by the institutional review board. Patients were identified from our Level 1 trauma registry. Inclusion criteria for this study was based on computed tomographic or angiographic evidence of thoracic aortic injury distal to the left subclavian artery. Two groups were identified: patients who underwent open repair (OR) and, patients who underwent endovascular repair (ER). Patient demographics, mechanism of injury, Injury Severity Score, associated injuries, comorbid conditions, intraoperative findings, postoperative complications, and duration of hospital stay were analyzed. Data regarding these patients and their injuries were retrieved from our trauma registry as well as chart review and outpatient records. The outcomes from OR and ER were compared using the Fisher exact test. P values less than 0.05 were considered statistically significant. RESULTS: During the 8-year period, 26 consecutive patients were treated for blunt aortic injury (OR = 12 and ER = 14). There were 20 men, and the mean age was 36 years. There were no differences between the groups in the mechanism of injury, Injury Severity Score, or number of associated injuries on initial presentation. On an intent-to-treat basis, the endovascular therapy was technically successful 100% of the time. There was no procedure-related mortality. There was 1 patient, however, in the OR group with presumed recurrent laryngeal nerve palsy. There was no incident of treatment-related paraplegia in either group. The 1-year survival for OR and ER patients was 93% and 92%, respectively. At 1 year, 25% of patients in the OR group and 18% of patients in the ER group required reinterventions. Mean operating room time was 309 minutes for the ERs and 383 minutes for the patients who underwent OR. Intraoperative blood product administration was greater in the OR group (P = .055); there was no difference between the groups, however, in the total blood products administered for a given hospital stay. The mean duration of hospital stay was 13 days for the OR group and 13.9 days for the ER group. CONCLUSION: There were no significant differences with respect to morbidity or mortality between these 2 groups. These data suggest that ER is at least as safe as OR for blunt aortic injury.
Authors:
Brett H Yamane; Girma Tefera; J R Hoch; W D Turnipseed; C W Acher
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-08-29
Journal Detail:
Title:  Surgery     Volume:  144     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-13     Completed Date:  2008-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  575-80; discussion 580-2     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Angioplasty / methods*
Aorta, Thoracic / injuries*,  surgery
Aortic Rupture / mortality,  radiography,  surgery*
Aortography
Blood Vessel Prosthesis Implantation / methods,  mortality
Child
Cohort Studies
Female
Humans
Injury Severity Score
Kaplan-Meiers Estimate
Male
Middle Aged
Probability
Prognosis
Retrospective Studies
Risk Assessment
Stents*
Survival Analysis
Thoracic Injuries / mortality,  radiography,  surgery
Thoracotomy / methods*
Wounds, Nonpenetrating / mortality,  radiography,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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