Endoluminal versus open repair of descending thoracic aortic rupture: a review of the National Trauma Databank

Abstract

Abstract:Objectives: Open repair for blunt thoracic aortic injury is associated with significant mortality. Interest in less invasive methods of repair has developed and results of several clinical studies have shown successful emergency repair with endovascular stent grafting. The purpose of this report was to compare endoluminal versus open repair of traumatic thoracic aortic injury in the National Trauma Databank. Methods:: We queried the databank from 2002 to 2006. We selected patients who had one of their International Classification of Disease-9 Diagnoses as 901.0, 'injury to the thoracic aorta', whose mechanism of injury was motor vehicle accident, fall or other transport, whose discharge disposition was known, and who received an endovascular or open repair. Results: The search resulted in 997 patients, one of whom had both procedures listed and was excluded from the analysis, 72% were males. A total of 875 underwent open repair and 121 had endoluminal repair. Both groups were similar in terms of age, demographics, associated injuries and hemodynamic status on presentation. Neither method of repair conferred significant advantage of survival, length of stay or ventilator days. Furthermore, there was no significant difference of pulmonary, renal, cardiac, infectious and neurologic complications between the two methods. Conclusion: Our findings suggest that in a large unselected population, endoluminal repair for aortic thoracic injury is not associated with decreased mortality or overall morbidity. Long-term data for endoluminal repair and its durability are lacking, especially in young patients. It may be premature to adopt endoluminal repair as the method of choice for all of these patients.

Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

“…Finally, in a prospective nonrandomized multicenter trial, TEVAR resulted in superior results versus open surgery in mortality (7.2% versus 23.5%) but no statistical difference in paraplegia (0.8% versus 2.9%) [15]. On balance, in unselected populations, TEVAR offers no survival advantage or reduction in paraplegia risk [16]. This observation may be attributable to the higher rates of complications with TEVAR for BTAI at less-experienced centers [15].…”

A systematic review and meta-analysis of endovascular versus open surgical repair for the traumatic ruptured thoracic aorta

“…A total of 1968 patients were analyzed from 21 articles. 3,10,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] The search flow is summarized in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart (Fig 1). These studies are summarized in Table II.…”

“…Finally, much of our analysis is heavily influenced by two studies. 20,35 Consequently, our conclusions unavoidably incorporate the limitations of these studies; much of the data come from voluntary rather than mandatory population-based databases, explaining why much of our data are missing precise information on operative technique as well as radiologic and anatomic detail. Overall, the dependence on these studies is likely to increase the effect of selection bias on our analysis.…”

“…Subanalysis. We have performed a subanalysis comparing the postoperative outcomes of the two major studies by Xenos et al 35 and Conrad et al 20 against the outcomes reported by the rest of the studies to assess for any possible bias. The outcomes reported did not significantly differ in terms of postoperative neurologic deficits and mortality rates between these articles.…”

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“…Blunt thoracic aortic trauma, including aortic transection, has a high mortality and survivors often have numerous other injuries [4]. Several studies have demonstrated that endovascular thoracic aortic repair for trauma has a better outcome than open aortic repair [5][6][7]. Endovascular repair offers lower morbidity and mortality, reducing the combined rates from around 19% to 9% [8].…”