Endovascular thoracic aortic transection repair has equivalent survival to open repair after blunt thoracic aortic injury

Abstract

Background: Blunt thoracic aortic injury (BTAI) is highly lethal and its management has evolved with the advent of endovascular approaches. We hypothesized that endovascular repair (ER) would have equivalent/improved survival compared to open repair (OR). The aim of our study was to review our center's morbidity and mortality after BTAI.

Methods: Our Level I trauma center registry was queried for BTAI between 2002-2015. This cohort was stratified into three groups: ER, OR and those patients managed non-operatively (NOP). Primary endpoint was mortality and secondary endpoints included complications after repair and freedom from re-intervention at follow-up.

Results: Among 81 patients with BTAI, there was a 58% mortality at presentation with a mean Injury Severity Score (ISS) of 65. From the remaining 34 patients alive after initial resuscitation, 12 (35%) patients were managed via OR, 12 (35%) via ER and 10 (30%) NOP. The mean ISS among these groups was 31, 44, and 30 respectively (P=0.6). 42% of patients in ER underwent coverage of the left subclavian artery without sequelae. There was one death in the OR and ER groups. Postoperative complications included one paraplegia after ER and one lower extremity weakness and vocal cord paralysis after OR. There was a shift in the year 2007 in the treatment of BTAI for ER instead of OR. Mean follow-up was 59.7±48.5months. None of the patients on follow-up required re-interventions.

Conclusions: Although BTAI still carries a high mortality rate, data from our trauma center suggest that ER has equivalent survival when compared to OR.