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INTERNATIONAL ANGIOLOGY

A Journal on Angiology


Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2017 Dec 13

DOI: 10.23736/S0392-9590.17.03902-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Endovascular thoracic aortic transection repair has equivalent survival to open repair after blunt thoracic aortic injury

Young ERBEN 1 , Gerardo TREJO 1, Adam J. BROWNSTEIN 2, Raymond A. JEAN 3, Bulat A. ZIGANSHIN 2, 4, Davide CARINO 2, John A. ELEFTERIADES 2, Adrian A. MAUNG 5

1 Section of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA; 2 Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA; 3 Department of Surgery, Yale University School of Medicine, New Haven, CT, USA; 4 Second Department of Surgical Diseases, Kazan State Medical University, Kazan, Russia; 5 Section of Trauma and Surgical Critical Care, Yale University School of Medicine, New Haven, CT, USA


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BACKGROUND: Blunt thoracic aortic injury (BTAI) is highly lethal and its management has evolved with the advent of endovascular approaches. We hypothesized that endovascular repair (ER) would have equivalent/improved survival compared to open repair (OR). The aim of our study was to review our center’s morbidity and mortality after BTAI.
METHODS: Our Level I trauma center registry was queried for BTAI between 2002-2015. This cohort was stratified into three groups: ER, OR and those patients managed non-operatively (NOP). Primary endpoint was mortality and secondary endpoints included complications after repair and freedom from re-intervention at follow-up.
RESULTS: Among 81 patients with BTAI, there was a 58% mortality at presentation with a mean Injury Severity Score (ISS) of 65. From the remaining 34 patients alive after initial resuscitation, 12 (35%) patients were managed via OR, 12 (35%) via ER and 10 (30%) NOP. The mean ISS among these groups was 31, 44, and 30 respectively (p=0.6). 42% of patients in ER underwent coverage of the left subclavian artery without sequelae. There was one death in the OR and ER groups. Post-operative complications included one paraplegia after ER and one lower extremity weakness and vocal cord paralysis after OR. There was a shift in the year 2007 in the treatment of BTAI for ER instead of OR. Mean follow-up was 59.7±48.5months. None of the patients on follow-up required re-interventions.
CONCLUSIONS: Although BTAI still carries a high mortality rate, data from our trauma center suggest that ER has equivalent survival when compared to OR.


KEY WORDS: TEVAR - Aortic transection - Blunt aortic injury - Open repair - Trauma

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Publication History

Article first published online: December 13, 2017
Manuscript accepted: December 4, 2017
Manuscript received: August 3, 2017

Cite this article as

Erben Y, Trejo G, Brownstein AJ, Jean RA, Ziganshin BA, et al. Endovascular thoracic aortic transection repair has equivalent survival to open repair after blunt thoracic aortic injury. Int Angiol 2017 Dec 13. DOI: 10.23736/S0392-9590.17.03902-5

Corresponding author e-mail

young.erben@yale.edu