title: Open repair of blunt thoracic aortic injury remains relevant in the endovascular era.
abstract: BACKGROUND
  Thoracic endovascular aneurysm repair (TEVAR) has been a major advance in the treatment of blunt thoracic aortic injury (BTAI), although many patients still undergo open repair. This study was undertaken to evaluate outcomes with open repair and TEVAR for BTAI.
  
  
  METHODS
  A retrospective review of all patients with BTAI at a single Level I trauma center from 2001 through 2009 was performed. Patients were grouped according to treatment modality, ie, open repair, TEVAR, or medical management. Direct comparison using standard statistical methods was made between patients undergoing open repair and TEVAR since late 2006 when TEVAR began at our institution using standard statistical methods. Outcomes variables included mortality, paraplegia, length of stay, ICU stay, and ventilator requirements.
  
  
  RESULTS
  There were 69 patients in the study, with 36 (52.2%) undergoing open repair, 10 receiving TEVAR (14.5%), 10 patients managed medically (14.5%), and 13 (18.8%) who died during triage. Overall mortality in the pre-TEVAR era was 29.6%. Since the introduction of TEVAR, there have been 8 open repairs. Patients undergoing open repair were significantly younger (32 vs 58 years; p = 0.002) and had smaller aortic diameter (18 mm vs 24.5 mm; p < 0.001) than those undergoing TEVAR. Overall mortality since the introduction of TEVAR has dropped to 12.0% (p = 0.097).
  
  
  CONCLUSIONS
  TEVAR and open repair should be viewed as complementary rather than competing modalities for the treatment of BTAI. Having both available allows selection of the most appropriate management technique for each patient, with subsequent improvement in outcomes.
authors.affiliation: University of Louisville, Department of Surgery, Louisville, KY 40201, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cannon
authors.forename: Jaimin R
authors.initials: JR
authors.lastname: Trivedi
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pagni
authors.forename: Amit
authors.initials: A
authors.lastname: Dwivedi
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Bland
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
authors.forename: Charles B
authors.initials: CB
authors.lastname: Ross
authors.forename: J David
authors.initials: JD
authors.lastname: Richardson
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000401:mortality / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D055815:Young Adult