title: Endovascular graft repair for blunt traumatic disruption of the thoracic aorta: experience at a nonuniversity hospital.
abstract: Blunt thoracic aortic injury (BAI) represents the second leading cause of death from blunt trauma. Admission rates for BAI are extremely low because instant fatality occurs in nearly 75 per cent of patients. Management strategies have transitioned from the more invasive immediate thoracotomy to delayed endograft repair with strict hemodynamic management. In this study, we assess outcomes and complications of open versus endograft repair for BAI at a nonuniversity hospital. Retrospective chart review was conducted on 49 patients admitted to a Level I trauma center who incurred BAI from 2004 to 2011. Collected data points included demographics, mortality, complication rates, and intensive care unit and hospital length of stay (LOS). Twenty-one patients underwent open thoracotomy (OPEN), whereas 28 patients were managed with thoracic endovascular aortic repair (TEVAR). The overall 30-day mortality rate was significantly lower comparing TEVAR to OPEN (7.1 vs 50%, P = 0.028); seven deaths occurred in the OPEN group versus two with TEVAR. Overall complications, including mortality, acute respiratory distress syndrome, renal failure, pneumonia, pulmonary embolism, and cardiac arrest, were fewer after TEVAR (32.1 vs 81.0%, P < 0.001) despite similar injury severity. Survivor hospital LOS (26.0 ± 15.3 vs 27.7 ± 18.7 days, P = 0.79), intensive care unit LOS (13.5 ± 10.9 vs 12.7 ± 8.8 days, P = 0.94), and ventilator days (11.4 ± 13.4 vs 16.4 ± 14.5 days, P = 0.25) were similar. Early nonoperative management with TEVAR for BAIs is a feasible and effective management strategy. Improved patient outcomes over traditional open thoracotomy in the presence of similar injury severity can be seen after TEVAR in the nonuniversity hospital setting.
authors.affiliation: F.H. Sammy Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Klima
authors.forename: Erin M
authors.initials: EM
authors.lastname: Hanna
authors.forename: A Britton
authors.initials: AB
authors.lastname: Christmas
authors.forename: Toan T
authors.initials: TT
authors.lastname: Huynh
authors.forename: Kristina E
authors.initials: KE
authors.lastname: Etson
authors.forename: Brett A
authors.initials: BA
authors.lastname: Fair
authors.forename: John M
authors.initials: JM
authors.lastname: Green
authors.forename: Jeko
authors.initials: J
authors.lastname: Madjarov
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000601:surgery*