title: Open Repair Versus Thoracic Endovascular Aortic Repair in Multiple-Injured Patients: Observations From a Level-1 Trauma Center.
abstract: BACKGROUND
  Blunt trauma of the thoracic aorta is a rare but potentially life-threatening entity. Intimal tears are a domain of non-operative management, whereas all other types of lesions should be repaired urgently. There is now a clear trend favoring minimally invasive stent grafting over open surgical repair.
  
  
  OBJECTIVE
  The aim of the present study was to retrospectively evaluate the mortality and morbidity with either treatment option. Therefore, a retrospective observational study was performed to compare two different treatment methods at two different time periods at one trauma center.
  
  
  METHODS
  Between 1977 and 2012, all severely injured patients referred to our level 1 trauma center were screened for blunt aortic injuries. We compared baseline characteristics, 30-day and overall mortality, morbidity, duration of intensive care treatment, procedure time, and transfusion of packed red blood between patients who underwent open surgical or stent repair.
  
  
  RESULTS
  During the observation period, 45 blunt aortic injuries were recorded. The average Injury Severity Score (ISS) was 41.8 (range 29 - 68). Twenty-five patients underwent Open Repair (OR), and another 20 patients were scheduled to emergency stent grafting. The 30-day mortality in the surgical and stent groups were 5/25 (20%) and 2/20 (10%), respectively. The average time for open surgery was 151 minutes; the mean time for stent grafting was 67 minutes (P = 0.001). Postoperative stay on the intensive care unit was between one and 59 days (median 10) in group one and between four and 50 days in group two (median 26)(P = 0.03). Patients undergoing OR required transfusion of 6.0 units of packed red cells in median; patients undergoing stent grafting required a median of 2.0 units of packed red cells (P < 0.001). In the stent grafting group, 30-day mortality was 10% (2/20).
  
  
  CONCLUSIONS
  Due to more sophisticated diagnostic tools and surgical approaches, mortality and morbidity of blunt aortic injuries were significantly reduced over the years compared to thoracic endovascular aortic repair and OR over two different time periods.
authors: Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
authors: Stephan
authors: S
authors: Brand
authors: Department of Cardiothoracic and Vascular Surgery, Public Hospital Braunschweig, Braunschweig, Germany.
authors: Ingo
authors: I
authors: Breitenbach
authors: Department of Diagnostic Radiology, Hannover Medical School, Hannover, Germany.
authors: Philipp
authors: P
authors: Bolzen
authors: Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
authors: Maximilian
authors: M
authors: Petri
authors: Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
authors: Christian
authors: C
authors: Krettek
authors: Division of Vascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Omke
authors: O
authors: Teebken
keywords: Aortic Rupture; In-Hospital Mortality; Injury Severity Score; Multiple Injuries; Traffic Accident