Endovascular Repair Compared With Operative Repair of Traumatic Rupture of the Thoracic Aorta: A Nonsystematic Review and a Plea for Trauma-Specific Reporting Guidelines

Abstract

The lack of reporting guidelines coupled with a paucity of follow-up data weakens any recommendation regarding the optimal choice of intervention. To address these deficiencies, we recommend reporting guidelines specific to the trauma population that will allow better risk adjustment and improve the quality of the evidence base.

Advances in the treatment of blunt thoracic aortic injuries

“…As far as delayed intervention is concerned, based on the findings of Demetriades et al (2009) described above, Karmy-Jones et al suggest delaying repair for patients with either significant injury or reversible physiologic derangement [36,40].…”

“…Importantly, the fact that unstable patients mostly underwent surgical repair biases the outcomes, according to the authors [40]. Even though ISS were similar between the groups, the authors found that only about half of the studies included described injury severity by ISS and about a third provided details on haemodynamic stability.…”

“…Only one reliable paper reviewing the relevant literature (between 2005 and 2010) was identified [40]. Karmy-Jones and colleagues (2011) included 62 retrospective reviews and 6 metaanalyses in their well-presented non-systematic review and in their conclusion they highlighted the need for guidelines specific to the trauma population for better risk adjustment and easier choice of optimal intervention [40].…”

“…Karmy-Jones et al (2011) recommend timing of repair to be documented in the following categorization: within 8 h of injury (immediate), within 24 h of injury (emergent), within 24 and 48 h of injury (urgent), more than 3 days but less than 7 days (subacute), more than a week (elective) [40].…”

“…Even though ISS were similar between the groups, the authors found that only about half of the studies included described injury severity by ISS and about a third provided details on haemodynamic stability. Finally, they recommend the use of the ASCOT (A Severity Characterization of Trauma) score to compare treatments, which is a useful tool to provide ''expected'' mortality risk after considering age, gender, presenting physiology and injury severity [40].…”