Endovascular repair of acute traumatic aortic injury: experience of a level-1 trauma center.

BACKGROUND: Endovascular repair of the thoracic aorta after traumatic rupture is an alternative to open repair and its use is becoming increasingly widespread. We aimed to determine the concurrent injuries sustained in patients who underwent thoracic endovascular aortic repair (TEVAR) as well as their Glasgow Coma Score (GCS) and Injury Severity Score (ISS). We also aimed to identify the intraoperative and early complications of TEVAR grafting up to 6 months after procedure and in addition identify the late postoperative complications occurring after 6 months after stent.

METHODS: Data were collected retrospectively between January 1998 and January 2012. The Australasian Vascular Audit and hospital trauma registry were used to obtain data related to those patients who underwent TEVAR at our center. Their characteristics were analyzed including associated injuries, delays to diagnosis, ISS scores, and early and long-term complications of endovascular repair.

RESULTS: Forty patients (mean age 41.3 ± 20.1) underwent stent graft repair of traumatic thoracic rupture at the aortic isthmus. Motor vehicle and motorbike accidents were responsible for 82.5% of presentations. Average ISS was 37 ± 13 (range 20-75) with an average GCS of 12.5 ± 3.8 at scene. Intraoperative death occurred in 2 cases (ISS score of 75), with 1 further death from severe head injures within 30 days. Average follow-up time was 5.48 ± 2.89 years (maximum 13 years).

CONCLUSIONS: Endovascular intervention is a safe and effective treatment, with minimal longer term complications seen after 5-year follow-up.