Emergency endovascular stent graft repair for acute blunt thoracic aortic injury: a retrospective case control study.
OBJECTIVE
To compare surgical and endovascular stent graft (ESG) treatment of blunt thoracic aortic injury (BAI) in the emergency setting.


METHODS
Retrospective case control study in two surgical intensive care units of a university hospital.


METHODS
30 patients who presented with BAI between 1995 and 2005: 17 treated surgically and 13 by ESG. The two groups were comparable for the severity of trauma and mean delay before treatment; the mean age was higher in the ESG group (46+/-18 vs. 35+/-15 years).


RESULTS
In the surgical group time spent in the operating theater was longer (310+/-130 vs. 140+/-48 min) and blood losses higher (2000+/-1300 vs. no significant bleeding); aortic clamping time was 48+/-20 min. The mortality rate was 15% with ESG (n=2) and 23% with surgery (n=4). Complications of the procedure were more frequent in the surgical group (1 vs. 7). In the ESG group there was one pulmonary embolism. In the surgical group there were three neurological complications, one acute aortic dissection, one perioperative rupture, one periprosthetic leak, and one septic shock. Two complications (postoperative aortic dissection and paraplegia) appeared in the same patient in the surgical group. Intensive care unit length of stay, duration of mechanical ventilation, and catecholamine support were similar in the two groups.


CONCLUSIONS
Stent graft for emergency treatment of BAI is efficient and is associated with fewer complications than surgical treatment.
Broux
Christophe
C
Surgical Intensive Care Unit, Grenoble University Hospital, 38043, Grenoble, France. cbroux@chu-grenoble.fr
Thony
Frédéric
F
Chavanon
Olivier
O
Bach
Vincent
V
Hacini
Rachid
R
Sengel
Christian
C
Blin
Dominique
D
Lavagne
Pierre
P
Girardet
Pierre
P
Jacquot
Claude
C
D000328:Adult; D019917:Blood Vessel Prosthesis Implantation; D004632:Emergency Medical Services; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013895:Thoracic Arteries / Q000293:injuries* / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000601:surgery*