Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury.
OBJECTIVE
Traumatic thoracic aortic injury (TTAI) is associated with high mortality rates. Data supporting thoracic endovascular aortic repair (TEVAR) to reduce mortality and morbidity for TTAI is limited to small series and meta-analyses. In this study, we evaluated the trends and outcomes of open surgery and TEVAR for TTAI in New York State.


METHODS
All cases of TTAI in New York State between 2000 and 2007 were extracted from the New York Statewide Planning and Research Cooperative System (SPARCS) database. A diagnosis by International Classification of Diseases, 9th Revision coding of TTAI was required for inclusion.


RESULTS
We identified 328 patients with TTAI who underwent surgical repair in New York State between 2000 and 2007; mean age of the cohort was 39.3 years +/- 18 years; 80% were male. Open repair of TTAI was performed in 79.6% and 20.4% underwent TEVAR. Open repair was performed for all cases of TTAI until the introduction of TEVAR in 2005; TEVAR exceeded the use of open repair for TTAI in 2006 and 2007. Additional major injuries were present in 71.7% in the open repair group vs 91.0% of the TEVAR group (P = .001). The overall in-hospital mortality rate for the 8-year period was significantly increased after open repair of TTAI compared with TEVAR: 17% vs 6%, (odds ratio [OR] 3.19, 95% confidence interval [CI], 1.11-9.23; P = .024). After controlling for the significant covariates, TEVAR independently reduced the risk of death following surgical intervention for TTAI compared with the open procedure (OR 3.8, 95% CI, 1.28-10.99; P = .010). Respiratory complications were the most common postoperative morbidity, and were significantly increased after open repair: 38% vs 24% (OR 1.95; 95% CI, 1.05-3.60; P = .032). There were no significant differences in cardiac complications, acute renal failure (ARF), paraplegia, or stroke. Endoleak and distal embolization each occurred in 9% of patients after TEVAR.


CONCLUSIONS
There has been a shift toward endovascular management of patients with TTAI. This change in surgical strategy has been associated with less postoperative mortality and fewer pulmonary complications in patients suffering from TTAI. TEVAR is associated with significant device-related complications.
Jonker
Frederik H W
FH
Department of Surgery and Radiology, Yale University School of Medicine, New Haven, CT 06510, USA. frederik.jonker@yale.edu
Giacovelli
Jeannine K
JK
Muhs
Bart E
BE
Sosa
Julie Ann
JA
Indes
Jeffrey E
JE
D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends; D019992:Databases as Topic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*; D055815:Young Adult