Management of blunt thoracic aortic injuries: endovascular stents versus open repair.
BACKGROUND
Endovascular stent graft (EV) technology has been successfully adapted to the repair of blunt traumatic aortic injuries. The purpose of this study was to compare the outcomes of patients treated with EV repair and open repair after blunt thoracic aortic trauma.


METHODS
A review of a tertiary trauma center's prospective trauma registry identified all patients who suffered a blunt traumatic thoracic aortic injury over an 11-year period (1991-2002). Operative interventions and outcomes were then compared.


RESULTS
Over an 11-year period, 18 patients underwent repair of a blunt thoracic aortic injury (EV, 6; open, 12). There were no significant differences in demographics, injury, or crash statistics between groups. The open group had a 17% early mortality rate (n = 2), a paraplegia rate of 16% (n = 2), and an 8.3% incidence of recurrent laryngeal nerve injury (n = 1). This is in contrast to a 0% rate of mortality, paraplegia, and recurrent laryngeal nerve injury in the EV group. A definite trend toward decreased morbidity, mortality, intensive care unit length of stay, and number of ventilator-dependent days was seen with EV repair.


CONCLUSIONS
We observed a clear trend toward improved outcomes after EV repair of thoracic aortic injuries compared with standard open repair. EV repair is emerging as the preferred method of repairing blunt thoracic aortic injuries in trauma patients with multiple injuries.
Ott
Michael C
MC
Trauma Program, Department of Surgery, London Health Sciences Centre, London, Ontario, Canada.
Stewart
Tanya Charyk
TC
Lawlor
D Kirk
DK
Gray
Daryl K
DK
Forbes
Thomas L
TL
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*