Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry

Arbabi, Cassra; DuBose, Joseph J.; Starnes, Benjamin W.; Saqib, Naveed U.; Quiroga, Elina; Miller, Charles C.; Azizzadeh, Ali; Charlton-Ouw, Kristofer M.; Afifi, Rana O.; McNutt, Michelle K.; Al-Rustum, Zain; Shrestha, Binod Bade; Starnes, Ben; Gilani, Rami; Turay, David; Luo-Owen, Xian; Bee, Tiffany K.; Moyer, Suzanne; DuBose, Joe; Shutze, William P.; Dockery, William D.; Petrey, Laura B.; Phelps, Timothy N.; Fox, Chuck; Moore, Ernest E.; Cralley, Alexis; Teixeira, Pedro G.; Leede, Emily; Buchanan, Frank R.; Ramos, Emilio; Ngoue, Marielle; Fox, Nicole; Shea, Lisa; Zielinski, Martin D.; Fischmann, Marianna Martini; Inaba, Kenji; Khor, Desmond; Magee, Gregory A.; Sheahan, Malachi; Unruh, Marie; Parry, Neil; Dubois, Luc; Berne, John D.; Puente, Ivan; Gomez, Mario; Mederos, Dalier R.; Bini, John K.; Herzing, Karen; Hardman, Claire; Schanzer, Andres; Aiello, Francesco; Arous, Edward J.; Arous, Elias J.; Jones, Douglas W.; Judelson, Dejah R.; Messina, Louis M.; Nguyen, Tammy; Simons, Jessica; Steppacher, Robert; Rezende-Neto, João; Haan, James M.; Lightwine, Kelly; Dunn, Julie; Smoot, Brittany; Hörer, Tal M.; McGreevy, David; Riambau, Vincent; Mestres, Gaspar; Yugueros, Xavier; Passman, Marc A.; Beck, Adam W.; Patterson, Mark A.; Pearce, Ben; Spangler, Emily L.; McFarland, Graeme E.; Sutzko, Danielle C.; Smeds, Matt; Zakhary, Emad; Williams, Michael L.; Wittgen, Catherine M.; Vogel, Todd R.; Eagleton, Matt; Gewertz, Bruce L.; Barmparas, Galinos; Kundi, Rishi; Morrison, Jonathan J.; Rossi, Peter J.; Pacini, Davide; Botta, Luca; Amodio, Ciro; Rimoldi, Pierantonio; D’Alessio, Ilenia; Compagnoni, Nicola Monzio; Aftab, Muhammad; Al-Musawi, Mohammed; Reece, T. Brett; Pal, Jay D.; Jacobs, Donald L.; Malgor, Rafael D.; Zarkowsky, Devin S.; Rajani, Ravi R.; Benarroch‐Gampel, Jaime; Ramos, Christopher; Schermerhorn, Marc L.; Wyers, Mark C.; Hamdan, Allen D.; Stangenberg, Lars; Lee, Andy; Davies, Mark; Jayakumar, Lalithapriya; Sideman, Matthew J.; Mitromaras, Christopher; Miserlis, Dimitrios; Brahmbhatt, Reshma; Darling, R. Clement; Caliste, Xzabia; Chang, Benjamin; Hnath, Jeffrey; Kreienberg, Paul B.; Kryszuk, Alexander; Laser, Adriana; Roddy, Sean P.; Saltzberg, Stephanie S.; Shah, Melissa; Warner, Courtney J.; Yeh, Chin-Chin; Reva, Viktor; Zhigalo, Viktor; Krasikov, Alexander V.; Trimarchi, Santi; Domanin, Maurizio; Babrowski, Trissa; Milner, Ross; Pocivavsek, Luka; Skelly, Christopher L.; Malka, Kimberly T.; Nolan, Brian

doi:10.1016/j.jvs.2021.09.028

Cited by 10 publications

(6 citation statements)

References 12 publications

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“…Among the patients, 2966 (71%) underwent early repair (<24 hours) for BTAI, while 1211 (29%) underwent delayed repair (>24 hours). The primary conclusions drawn from the study are as follows: 1) in the delayed repair group, the short-term mortality rate was significantly lower; 2) the ICU length of stay was significantly lower in the early group [4,10,11,[17][18]. No significant differences were noted in terms of preoperative characteristics or postoperative complications.…”

Section: Discussionmentioning

confidence: 85%

“…However, the ICU length of stay was significantly shorter in the early group (mean difference: -2.82 days), 95%CI; (-4.09 --1.56); p<0.0001; I2=55%). Figure 3 displays the length of stay in the intensive care unit (ICU) contrasted between both groups [4,10,11,[17][18]. We could not estimate differences regarding in-hospital stays due to severe heterogeneity between studies and likely different definitions of the starting timepoint.…”

Section: Primary Outcomementioning

confidence: 99%

“…Guidelines established by the SVS recommend early TEVAR for BTAI patients, with delayed TEVAR reserved for patients at high risk who have severe injuries or comorbidities [9]. Some reports [10] found no appreciable changes in patient outcomes between early and delayed TEVAR, while others reported significantly improved outcomes with delayed TEVAR [11]. These discrepancies have made it challenging to establish definitive criteria for the use of delayed TEVAR in BTAI cases and to determine its overall impact on patient survival.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early Versus Delayed Thoracic Endovascular Aortic Repair for Blunt Traumatic Aortic Injury: A Systematic Review and Meta-Analysis

Rudra,

Cardoso,

Echevarria

et al. 2023

Cureus

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Blunt aortic injury is the second most prevalent cause of patient fatalities post-trauma, closely following head injuries as the leading cause. In recent years, thoracic endovascular aortic repair (TEVAR) has evidently improved survival rates and reduced complications in patients suffering from blunt traumatic aortic injury (BTAI) in comparison to open surgery and non-operative management.It is difficult to characterize the appropriate criteria for the timing of TEVAR, whether early or delayed for BTAI, considering the discrepancies related to timing. Electronic databases, including PubMed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase, were searched through April 2023. The primary outcomes were short-term mortality and hospital and intensive care unit (ICU) stays. Time to TEVAR, acute respiratory distress syndrome, sepsis, deep vein thrombosis, delayed stroke, and renal failure were also evaluated.We included a total of seven studies, comprising 4177 patients who met the inclusion criteria. Short-term mortality was significantly higher in the early TEVAR group (RR: 1.86; 95% confidence interval (CI); (1.26-2.74); p<0.001; I 2 =33%). In contrast, the ICU length of stay was significantly shorter in the early group (mean difference: -2.82 days; 95% CI; (-4.09 --1.56); p<0.0001; I 2 =55%). There was no significant difference between both groups in the presenting profile or postoperative complications.Patients undergoing delayed TEVAR had markedly lower mortality rates but a longer ICU stay. The need for future studies with more robust designs is imperative to investigate the factors influencing the timing of repair and the associated outcomes.

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Section: Discussionmentioning

confidence: 85%

Section: Primary Outcomementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early Versus Delayed Thoracic Endovascular Aortic Repair for Blunt Traumatic Aortic Injury: A Systematic Review and Meta-Analysis

Rudra,

Cardoso,

Echevarria

et al. 2023

Cureus

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“…Non-RF-induced closed TAI is associated with shearing forces, abrupt deceleration, and acute changes in intravascular pressure. These BTAI cases typically involve the aortic isthmus ( 6 , 7 ). By contrast, RF-induced TAI predominantly affects the aorta adjacent to the broken ends of RFs or surrounded by free bone fragments ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury-a case series application of either anteroposterior or lateral forces upon the relatively mobile ascending thoracic aorta, with shearing forces predominantly at the aortic isthmus. The other major physical theory underlying BTAI is direct penetrating injury from rib and thoracic vertebral fractures (5)(6)(7). About 80% of patients with BTAI die before admission, and the inhospital mortality rate is as high as 50% (5,8).…”

Section: Introductionmentioning

confidence: 99%

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Wang¹,

Wu²,

Guo³

et al. 2022

J Thorac Dis

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Background: Delayed thoracic aortic injury (DTAI) induced by left closed rib fractures (RFs) is a clinically rare blunt injury to the thoracic aorta with an insidious onset. DTAI is very prone to missed diagnosis due to the unreliability of using the initial post-injury computed tomography (CT) scan to explicitly detect any signs of an aortic injury, potentially leading to a fatal hemorrhage. Timely diagnosis and treatment are therefore key to preventing such deadly complications. With that said, not all cases of left RFs lead to delayed aortic injuries, so how can surgeons tell which cases are to be culled and focused on? Also, what kinds of treatment should be administered upon detection? Methods: A retrospective analysis was performed on the clinical data of DTAI cases induced by left closed RF that were admitted to our Hospital from June 2015 through June 2020. Injuries to the aortic tunica adventitia or the elastic layer were intraoperatively confirmed. CT scan findings, locations and numbers of RFs, as well as the choices of surgical procedure were reviewed postoperatively. In addition, a literature review was conducted to analyze characteristics shared by similar cases.Results: This study included 7 patients treated by our hospital and 8 reported in the literature. The broken ends of RFs causing aortic wall injury (including the tunica adventitia) were all found in the medial to the lateral erector spinae. All patients in our hospital received internal fixation for RFs and thoracoscopic removal of free bone fragments (if any). Concomitant injuries were managed either by simultaneous or staged surgery.Conclusions: For multiple left RFs with the broken ends located in the inside of the lateral erector spinae, the number of fractured ribs ≥4 and a smaller number of fractured ribs with multiple fractures in a single rib are important factors for DTAI. Active surgical intervention is recommended for patients with these important factors. The specific intervention is tailored to each patient's particular needs to eliminate the risk of developing life-threatening thoracic aortic injury (TAI) and rupture.

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Delayed Endovascular Repair With Procedural Anticoagulation: A Safe Strategy for Blunt Aortic Injury

Zambetti¹,

Zickler²,

Lewis³

et al. 2022

Annals of Vascular Surgery

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Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry

Cited by 10 publications

References 12 publications

Early Versus Delayed Thoracic Endovascular Aortic Repair for Blunt Traumatic Aortic Injury: A Systematic Review and Meta-Analysis

Early Versus Delayed Thoracic Endovascular Aortic Repair for Blunt Traumatic Aortic Injury: A Systematic Review and Meta-Analysis

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Delayed Endovascular Repair With Procedural Anticoagulation: A Safe Strategy for Blunt Aortic Injury

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