Prospective Study of Blunt Aortic Injury

Fabian, Timothy C.; Richardson, J. David; Croce, Martin A.; Smith, J. Stanley; Rodman, George H.; Kearney, Paul A.; Flynn, William J.; Ney, Arthur L.; Cone, John B.; Luchette, Fred A.; Wisner, David H.; Scholten, Donald J.; Beaver, Bonnie L.; Conn, Alasdair; Coscia, Robert; Hoyt, David B.; Morris, John A.; Harviel, J. Duncan; Peitzman, Andrew B.; Bynoe, Raymond P.; Diamond, Daniel L.; Wall, Matthew J.; Gates, Jonathan D.; Asensio, Juan A.; McCarthy, Mary C.; Girotti, Murray J.; VanWijngaarden, Mary; Cogbill, Thomas H.; Levison, Marc A.; Aprahamian, Charles; Sutton, J. E. G.; Allen, Charles F.; Hirsch, Erwin F.; Nagy, Kimberly; Bachulis, Ben L.; Bales, Charles R.; Shapiro, Marc J.; Metzler, Michael H.; Conti, Vincent R.; Baker, Christopher C.; Bannon, Michael P.; Ochsner, M. Gage; Thomason, Michael; Hiatt, Jonathan R.; OʼMalley, Keith F.; Obeid, Farouck N.; Gray, Perry R.; Bankey, Paul E.; Knudson, M. Margaret; Dyess, Donna L.; Enderson, Blaine L.

doi:10.1097/00005373-199703000-00003

Cited by 688 publications

(48 citation statements)

References 24 publications

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“…Earlier series showed high rates of paraplegia following open repair. 3 Our results demonstrated similar low occurrence rates for paraplegia, as well as acute renal failure, for open repair and TEVAR, which is in line with more recent studies. 16, 20 Shorter length of stay after TEVAR has also been reported previously.…”

Section: Discussionsupporting

confidence: 93%

“…In 1997, a large prospective multicenter trial conducted by the American Association for the Surgery of Trauma (AAST) reported that the operative mortality after open repair was 31%, with paraplegia occurring in 9% of patients. 3 These rates are substantially higher than those for open repair in the present study where mortality was 12.7% and paraplegia was 0.8%. In that same year, endovascular stent-graft placement for TTAI was first described.…”

Section: Discussioncontrasting

confidence: 59%

“…Also, the observed high prevalence of orthopedic injuries is often observed in blunt trauma patients, and is in line with prior studies reporting on blunt TTAI. 3 …”

Section: Discussionmentioning

confidence: 99%

“…Various studies have suggested an in-hospital mortality of 15% to 30%, beginning with Parmley’s 1958 study. 2, 3 Early studies assessing perioperative outcome following open repair showed poor results, with both high surgical mortality and morbidity, of which a high paraplegia rate was most notable. 4 …”

Section: Introductionmentioning

confidence: 99%

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National trends in utilization and outcome of thoracic endovascular aortic repair for traumatic thoracic aortic injuries

Ultee

Soden

Chien

et al. 2016

Journal of Vascular Surgery

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Introduction Endovascular repair of traumatic thoracic aortic injuries (TTAI) is an alternative to conventional open surgical repair. Single institution studies have shown a survival benefit with TEVAR, but it is not clear if this is being realized nationally. The purpose of our study was to document trends in the increase in utilization of TEVAR and its impact on outcomes of TTAI nationally. Methods Patients admitted with a traumatic thoracic aortic injury between 2005 and 2011 were identified in the National Inpatient Sample (NIS). Patients were grouped by treatment into TEVAR, open repair, or nonoperative management groups. Primary outcomes were relative utilization over time and in-hospital mortality. Secondary outcomes included postoperative complications and length of stay. Multivariable logistic regression was performed to identify independent predictors of mortality. Results A total of 8384 patients were included, with 2492 (29.7%) undergoing TEVAR, 848 (10.1%) open repair, and 5044 (60.2%) managed nonoperatively. TEVAR has become the dominant treatment option for TTAI over the study period, starting at 6.5% of interventions in 2005 and accounting for 86.5% of interventions in 2011 (P<.001). Nonoperative management declined concurrently with the widespread of adoption TEVAR (79.8% to 53.7%, P<.001). In-hospital mortality following TEVAR decreased over the study period (33.3% in 2005 to 4.9% in 2011, P<.001), while an increase in mortality was observed for open repair (13.9% to 19.2%, P<.001). Procedural mortality (either TEVAR or open repair) decreased from 14.9% to 6.7% (P<.001), and mortality following any TTAI admission declined from 24.5% to 13.3% over the study period (P<.001). In addition to lower mortality, TEVAR was followed by fewer cardiac complications (4.1% vs. 8.5%), P<.001), respiratory complications (47.5% vs. 54.8%, P<.001), and shorter length of stay (18.4 vs. 20.2 days, P=.012) compared to open repair. In adjusted mortality analyses, open repair proved to be associated with twice the mortality risk compared to TEVAR (OR: 2.1, 95% CI: 1.6 – 2.7), while nonoperative management was associated with more than a four-fold increase in mortality (OR: 4.5, 95% CI: 3.8 – 5.3). Conclusions TEVAR is now the dominant surgical approach in TTAI with substantial perioperative morbidity and mortality benefits over open aortic repair. Overall mortality following admission for TTAI has declined, which is most likely the result of both the replacement of open repair by TEVAR, as well as the broadened eligibility for operative repair.

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 59%

“…Also, the observed high prevalence of orthopedic injuries is often observed in blunt trauma patients, and is in line with prior studies reporting on blunt TTAI. 3 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

National trends in utilization and outcome of thoracic endovascular aortic repair for traumatic thoracic aortic injuries

Ultee

Soden

Chien

et al. 2016

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…1,5,6,9,10 As for minimal aortic injury these lesions are immediately evident at CT, even when small in size, with less than 1-cm intimal flap and with non-significant haematoma.…”

Section: [ ( ) T D $ F I G ]mentioning

confidence: 99%