Endoluminal versus open repair of descending thoracic aortic rupture: a review of the National Trauma Databank

Abstract

Objectives: Open repair for blunt thoracic aortic injury is associated with significant mortality. Interest in less invasive methods of repair has developed and results of several clinical studies have shown successful emergency repair with endovascular stent grafting. The purpose of this report was to compare endoluminal versus open repair of traumatic thoracic aortic injury in the National Trauma Databank. Methods:: We queried the databank from 2002 to 2006. We selected patients who had one of their International Classification of Disease-9 Diagnoses as 901.0, ‘injury to the thoracic aorta’, whose mechanism of injury was motor vehicle accident, fall or other transport, whose discharge disposition was known, and who received an endovascular or open repair. Results: The search resulted in 997 patients, one of whom had both procedures listed and was excluded from the analysis, 72% were males. A total of 875 underwent open repair and 121 had endoluminal repair. Both groups were similar in terms of age, demographics, associated injuries and hemodynamic status on presentation. Neither method of repair conferred significant advantage of survival, length of stay or ventilator days. Furthermore, there was no significant difference of pulmonary, renal, cardiac, infectious and neurologic complications between the two methods. Conclusion: Our findings suggest that in a large unselected population, endoluminal repair for aortic thoracic injury is not associated with decreased mortality or overall morbidity. Long-term data for endoluminal repair and its durability are lacking, especially in young patients. It may be premature to adopt endoluminal repair as the method of choice for all of these patients.