title: Late outcomes following open and endovascular repair of blunt thoracic aortic injury.
abstract: BACKGROUND
  Previous studies have focused on early outcomes of open (descending thoracic aortic repair [DTAR]) and endovascular (thoracic endovascular aneurysm repair [TEVAR]) repair of blunt aortic injury (blunt thoracic aortic injury [BTAI]). Late results remain ill-defined and are the focus of this study.
  
  
  METHODS
  One hundred nine patients (1992-2010) underwent repair for BTAI. Mean age was 39.0 years (73.4% male). DTAR was performed in 90, with left heart bypass (85) or hypothermic arrest (5). TEVAR was used in 19 of 45 patients treated since 2002. A strategy of selective delayed repair has been used since 1997, with 54 of 75 patients treated with delayed repair in this interval. The primary outcome was vital status (100% follow-up; mean, 103.9 months).
  
  
  RESULTS
  Mean Injury Severity Score was 39.5. Thirty-day mortality was 4.6% (n = 5). Early morbidity included permanent spinal cord ischemia (SCI, 1.8%), stroke (2.8%), and need for permanent dialysis (1.8%). Independent predictors of a composite outcome of early mortality and these morbidities included age >60 years (odds ratio [OR], 8.4; P = .015), increasing preoperative creatinine (OR, 7.9; P = .017), and occurrence of postoperative sepsis (OR, 9.6; P = .021). Fifteen-year Kaplan-Meier survival was 81.3%. Independent predictors of late mortality included age >60 years (Cox hazard ratio [HR], 4.1; P = .01), increasing creatinine (HR, 9.1; P < .001), or occurrence of postoperative SCI (HR, 20.6; P < .001), but not repair type (P = .73). Endograft collapse occurred in one patient, necessitating reintervention. Freedom from aortic reintervention at 4 years was higher after open repair (DTAR 100% vs TEVAR 94%; P = .03).
  
  
  CONCLUSIONS
  With careful selection, open or endovascular repair of BTAI has excellent early and late results. Although TEVAR has an increased risk for reintervention, factors other than treatment strategy impact late survival. These data support the growing role of an endoluminal approach for BTAI in anatomically appropriate patients.
authors.affiliation: Department of Surgery, University of Michigan Hospitals, Ann Arbor, Mich, USA. hjpatel@med.umich.edu
authors.forename: Himanshu J
authors.initials: HJ
authors.lastname: Patel
authors.forename: Mark R
authors.initials: MR
authors.lastname: Hemmila
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
authors.forename: Amy C
authors.initials: AC
authors.lastname: Diener
authors.forename: G Michael
authors.initials: GM
authors.lastname: Deeb
mesh_terms: D000328:Adult; D000367:Age Factors; D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D003404:Creatinine / Q000097:blood; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D012720:Severity of Illness Index; D020760:Spinal Cord Ischemia / Q000209:etiology; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000401:mortality / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003404:Creatinine