Open and Endovascular Abdominal Aortic Injury Repair Outcomes in Polytrauma Patients.
BACKGROUND
The management of patients with abdominal aortic injury (AAI) remains challenging. Open repair of AAI is still the standard of care although it is associated with high mortality. In past few years, endovascular surgery has evolved as a less invasive alternative to open surgery in emergency settings. The objective of this study was to compare outcomes after open repair versus endovascular repair of AAI in polytrauma patients.


METHODS
The National Trauma Data Bank, from 2008 to 2012, was queried to identify trauma patients undergoing open and endovascular repair of AAI using International Classification of Diseases, ninth Edition, and Clinical Modification codes. Data reviewed included demographics, type of associated injury, type of operative management, and complications. Factors independently associated with mortality were evaluated using multivariate logistic regression model.


RESULTS
Of 325 injured patients with AAI, 91 patients underwent endovascular repair and 234 patients underwent open repair. Of these, 80.6% were male, with a mean age of 35.70 years, and a mean injury severity score (ISS) was 30.59 for patients undergoing open repair and 31.56 for endovascular repair. Associated traumatic injuries included bowel injuries 57.5%, liver-pancreas injuries 36.6%, splenic injuries 14.8%, renal injuries 15.7%, and retroperitoneal injuries 19.1%. In-patient mortality for patients undergoing the open repair cohort was 63.7% and 20.9% for patients in the endovascular cohort (P < 0.001). The endovascular repair cohort patients had a higher incidence of pneumonia 17.6% as compared to open repair cohort 5.1% (P < 0.001). Similarly, patients in the endovascular repair cohort also had a higher abdominal compartment syndrome (4.4% vs. 0.4% in the open repair cohort, P = 0.009), postoperative acute kidney injury (9.9% endovascular repair cohort vs. 6.4% in the open repair cohort, P = 0.281), and acute mesenteric ischemia (1.1%). After controlling for associated injuries, acidosis, blood pressure at presentation, age, and ISS, patients in the open repair cohort had 6.58 times higher odds (confidence interval: 3.25-13.33; P < 0.001) of mortality as compared to the endovascular repair cohort.


CONCLUSIONS
Endovascular repair of abdominal aorta in polytrauma patients seems to be feasible and may improve survivorship in appropriately selected patients. More research is needed to understand to identify indications for endovascular repair versus open repair.
Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Surgery, San Joaquin General Hospital, UC Davis, French Camp, CA. Electronic address: Dayama.md@gmail.com.
Anand
A
Dayama
Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Aksim
A
Rivera
Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Odunayo
O
Olorunfemi
Department of Surgery, San Joaquin General Hospital, UC Davis, French Camp, CA.
Ahmed
A
Mahmoud
Department of Surgery, San Joaquin General Hospital, UC Davis, French Camp, CA.
Catherine A
CA
Fontecha
Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY.
John
J
McNelis
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D055815:Young Adult