Open versus endovascular repair of acute aortic transections--a non-randomized single-center analysis

Abstract

Purpose: To analyze early and midterm results after open and endovascular treatment of traumatic aortic transections (TAT).

Methods: Between January 1990 and December 2007, a total of 28 patients were treated for TAT due to blunt deceleration trauma. Open repair (Group 1: OR) was performed in 14 patients (50%) and thoracic endovascular aortic repair (Group 2: TEVAR) in 14 (50%). A retrospective analysis of these patients was performed. For risk stratification, the Injury Severity Score (ISS), the Glascow Coma Scale, the Revised Trauma Score, and the Trauma Injury Severity Score were used. Mean follow-up was 52.0 months (range 0.1-187.2 months)

Results: There was no difference regarding age and hemodynamic status in either group. Risk stratification with ISS was equal in either group (OR: median 50, range 22-66 versus TEVAR: median 45, range 29-75; p = 0.354). The in-hospital mortality was 25%, with no statistical difference in either group (OR: 35.7% versus TEVAR 14.2%; p = 0.117). Procedure-related complications occurred in one patient in the OR group (bleeding) and in one patient in the TEVAR group (limb ischemia). There was no procedure-associated neurological complication in either group. One patient showed a proximal type I endoleak which is under surveillance. Early conversion due to stent graft infection was necessary in one patient. The actuarial survival estimates were 82% at 1 year and 72.5% at 3 and 5 years, with no statistical difference in both groups (p = 0.077).

Conclusions: Endovascular treatment of acute aortic transections is associated with a reduced perioperative mortality compared to conventional surgery with no difference regarding midterm survival. Long-term data are still required to define the definite role of TEVAR in TAT.