Open repair versus thoracic endovascular aortic repair for treating traumatic aortic injury.

BACKGROUND/

OBJECTIVE

Blunt traumatic aortic injury (BTAI) is rare and fatal. Treatment has evolved with advances in imaging and the emergence of thoracic endovascular aortic repair (TEVAR). This study reports a single-center, 5-year experience of TEVAR and open repair for BTAI.

METHODS

Patients with BTAI treated at a level I trauma center from 2014 to 2019 were retrospectively reviewed with patient charts and successive computed tomography angiography images. Patients were grouped according to treatment modality: open repair, TEVAR, or medical management, chosen based on patients' characteristics and injury severity. Groups were compared in terms of preoperative demographics, injury characteristics, operative variables, short-term, and long-term outcomes.

RESULTS

Forty-two patients were included in the study: 16 (38%) underwent open repair, 17 (40.4%) underwent TEVAR, seven (16.6%) were managed medically, and two (4.7%) died during triage. The median age was 49 years (interquartile range [IQR], 38-57.5 years), and 92.5% were male; the median Injury Severity Score was 33 (IQR, 29-41). Overall mortality was 7.5%. The median hospital stay was 33 days (IQR, 19.5-58.5). Patients undergoing open repair were significantly younger (43 vs. 55 years; p = 0.002) and had a smaller aortic diameter (22.3 vs. 24.0 mm; p=<0.001) than those undergoing TEVAR. No BTAI-related late mortality or reintervention was observed during follow-ups.

CONCLUSION

This study demonstrated excellent outcomes with multidisciplinary team efforts and appropriate application of treatment modality. TEVAR is ideal for older or severely injured patients; open repair is an important alternative for young patients or patients with unsuitable aortic anatomy.