Endovascular Repair in Traumatic Thoracic Aortic Injuries: Comparison with Open Surgical Repair

Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

“…Early in the experience, patients were selected for TEVAR based on contraindications to open repair for a high a risk of mortality from comorbidity and associated injuries; over time, 11 of 16 centers that described indications broadened the application to all patients with suitable anatomy (6,22,29,31,32,34,36,37,(41)(42)(43)45). In one institution, TEVAR was reserved for those with concomitant brain injury (39).…”

“…Brachial access was used for the diagnostic catheter at 37% of the centers; left at five (33,34,37,41) and right at three (39,40,42). A femoral approach for stent-graft delivery was preferred, although external iliac or aortic access was required in 11% of patients as a result of vessel size or delivery device length limitations (6,40,41,45). An extra-stiff guide wire (Amplatz; Cook, Bloomington, Indiana; or Meier; Boston Scientific, Natick, Massachusetts) was advanced to the ascending aorta, the diagnostic catheter was exchanged for an 18 -22-F sheath, and the device was advanced.…”

“…Deployment was performed under fluoroscopic guidance. To minimize the "windsock effect" that could displace the partially deployed graft, half the authors reduced systolic blood pressure pharmacologically to 70 mm Hg (range, 50 -90 mm Hg) (33,42,45), whereas 16% administered adenosine to induce asystole (6,29,38). A confirmation digital subtraction angiogram assured exclusion of the lesion.…”

“…plegia rate of 5.7% in the open surgical cohort were higher than the respective rates in the contemporaneous BTAI open surgical repair literature of 14.7% and 3.3%; however, the difference was not significant (Table 3) (4,5,7,10,12,15, 23,78,79). When reported, systemic complications with endovascular repair were reduced compared with open repair(32,33,36,44,45). The weighted pooled mean procedure times were 148 minutes (range, 97-165 min) for TEVAR and 238 minutes (range, 174 -280 min) for operative repair(30,32,35,37,40,41,44,45).…”

“…When reported, systemic complications with endovascular repair were reduced compared with open repair(32,33,36,44,45). The weighted pooled mean procedure times were 148 minutes (range, 97-165 min) for TEVAR and 238 minutes (range, 174 -280 min) for operative repair(30,32,35,37,40,41,44,45). Intensive care unit stay averaged 12 days (range, 1-18 d) after TEVAR, versus 12.8 days (range, 3.5-22 d) after open repair(30,32,37,38,40,41,44,45).…”