title: Early aortic repair worsens concurrent traumatic brain injury.
abstract: BACKGROUND
  Blunt thoracic aortic injury (BTAI) and traumatic brain injury (TBI) are the leading causes of death after blunt trauma, and TBI is common among patients with BTAI. Although aspects of aortic management, such as repair timing and procedural anticoagulation therapy, may complicate TBI, the optimal management of these patients is undefined.
  
  
  METHODS
  Adults with BTAI and moderate to severe TBI admitted to a level I trauma center over 12 years were retrospectively analyzed; patients presenting in extremis were excluded. The primary outcome was neurologic progression within 48 hours of aortic repair. Patients undergoing nonoperative aortic management served as controls for baseline TBI progression. Secondary outcomes were aortic morbidity and mortality and overall inpatient survival.
  
  
  RESULTS
  Of 309 patients with BTAI, 138 had concurrent TBI, and 75 were included for analysis. Twenty-two (29%) were treated nonoperatively, 29 (39%) had early aortic repair (17 open, 12 endovascular), and 24 (32%) had delayed repair (3 open, 21 endovascular). The severity of TBI was similar between groups. Early aortic repair within 24 hours of admission was independently associated with worsening TBI, regardless of repair modality or anticoagulation use. In contrast, patients undergoing delayed repair had no perioperative neurologic progression despite procedural anticoagulation therapy. Early aortic repair was also associated with increased aortic morbidity and mortality.
  
  
  CONCLUSIONS
  For patients with BTAI and TBI, early aortic intervention is associated with progressive TBI regardless of repair modality, as well as increased aortic morbidity and mortality. Patients not requiring emergent intervention can undergo delayed repair with full anticoagulation therapy.
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rabin
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: dharris@smail.umaryland.edu.
authors.forename: Donald G
authors.initials: DG
authors.lastname: Harris
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Crews
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ho
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Center for Aortic Diseases, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Taylor
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Center for Aortic Diseases, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Rajabrata
authors.initials: R
authors.lastname: Sarkar
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: James V
authors.initials: JV
authors.lastname: O'Connor
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Center for Aortic Diseases, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Crawford
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D001027:Aortography; D015142:Baltimore / Q000453:epidemiology; D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013898:Thoracic Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome