title: Update on blunt thoracic aortic injury: fifteen-year single-institution experience.
abstract: OBJECTIVE
  Despite improvements in the management of blunt thoracic aortic injury, mortality remains high. We report our experience with blunt thoracic aortic injury at a level 1 trauma center over the past 15 years.
  
  
  METHODS
  Between January 1, 1997, and January 1, 2012, data on 338 patients who presented with suspected blunt thoracic aortic injury were entered into the University of Texas Medical School at Houston Trauma Center Registry. A total of 175 patients (52%) underwent thoracic aortic repair; 29 (17%) had open repair with aortic crossclamping, 77 (44%) had open repair with distal aortic perfusion, and 69 (39%) had thoracic endovascular aortic repair. Outcomes were determined, including early mortality, morbidity, length of stay, and late survival. Multiple logistic regression analysis was used to compute adjusted estimates for the effects of the operative technique.
  
  
  RESULTS
  The early mortality for all patients with blunt thoracic aortic injury was 41% (139/338). Early mortality was 17% (27/175) for operative aortic interventions, 4% (3/69) for thoracic endovascular aortic repairs, 31% (11/29) for open repairs with aortic crossclamping, and 14% (11/77) for open repairs with distal aortic perfusion. Survival for thoracic endovascular aortic repair at 1 year and 5 years was 92% and 87%, respectively. Survival for open repair at 1, 5, 10, and 15 years was 76%, 75%, 72%, and 68%, respectively.
  
  
  CONCLUSIONS
  Blunt thoracic aortic injury remains associated with significant early mortality. Delayed selective management, when applied with open repair with distal aortic perfusion and the use of thoracic endovascular aortic repair, has been associated with improved early outcomes. The long-term durability of thoracic endovascular aortic repair is unknown, necessitating close radiographic follow-up.
authors.affiliation: Cardiothoracic & Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Tex, USA. Anthony.l.estrera@uth.tmc.edu
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.forename: Gustavo
authors.initials: G
authors.lastname: Guajardo-Salinas
authors.forename: Sheila
authors.initials: S
authors.lastname: Coogan
authors.forename: Kristofer
authors.initials: K
authors.lastname: Charlton-Ouw
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D055815:Young Adult