Blunt thoracic aortic injury: A single institution comparison of open and endovascular management

Peter I. Midgley, Kent S. MacKenzie, Marc M. Corriveau, Daniel I. Obrand, Cherrie Abraham, Paola Fata, Oren K. Steinmetz

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Objective: To review the treatment of blunt thoracic aortic injuries (BAI) at a single institution over the past 12 years and compare pre-, peri-, and postoperative variables and outcomes of both open (OR) and thoracic endovascular (TEVAR) repair of these injuries. Methods: All cases of confirmed BAI from 1994 to present were included in this retrospective review. Data collected included demographic data, injury severity score, Glasgow coma score, arrival hemodynamic variables, and associated injuries. Operative data included: type of procedure (OR or TEVAR), duration of procedure, need for and amount of blood transfused, use of anticoagulation, type of anesthesia, and service performing the procedure. Outcomes evaluated were: death, paraplegia, length of stay, days ventilated, and procedure related complications. Specific to EVAR; access, stent graft type and number, presence of endoleak and long-term clinical and radiologic follow-up were evaluated. Results: Thirty cases of blunt thoracic aortic injury were identified. Two patients received no treatment and died, 28 patients were treated (OR 16, TEVAR 12) and included for comparison. There were no significant differences between groups with respect to preoperative variables with the exception of significantly more associated intra-abdominal injuries in the TEVAR group (P = .03). Five patients in the OR group (31.2%) died in the perioperative period. There were no deaths in the TEVAR group (P =.05). One OR patient (6.25%) suffered postoperative paraplegia. No paraplegia occurred in the TEVAR group. Intraoperative variables were similar between groups with the exception of mean units of blood transfused (OR 8.5 units, vs TEVAR 0.2 units, P = .002). Ten patients in the OR group either died or had a procedure related complication compared with none in the TEVAR group (P = .001). There was no difference in length of stay or length of mechanical ventilation between the groups. There were no procedure or device related complications in the TEVAR group during follow-up (mean 15.3 months, range 1 to 53.5 months). Conclusions: Endovascular repair of BAI results in significantly less combined mortality and morbidity when compared to OR. Significantly less blood is needed intraoperatively in the TEVAR group. No complications from stent graft insertion have been observed during follow-up. Endovascular repair is replacing open repair as the treatment of choice for BAI at our institution.

Original languageEnglish (US)
Pages (from-to)662-668
Number of pages7
JournalJournal of Vascular Surgery
Volume46
Issue number4
DOIs
StatePublished - Oct 2007
Externally publishedYes

Fingerprint

Thoracic Injuries
Nonpenetrating Wounds
Thorax
Paraplegia
Stents
Length of Stay
Transplants
Endoleak
Abdominal Injuries
Endovascular Procedures
Perioperative Period
Injury Severity Score
Wounds and Injuries
Coma
Artificial Respiration
Therapeutics
Anesthesia
Hemodynamics
Demography
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Midgley, P. I., MacKenzie, K. S., Corriveau, M. M., Obrand, D. I., Abraham, C., Fata, P., & Steinmetz, O. K. (2007). Blunt thoracic aortic injury: A single institution comparison of open and endovascular management. Journal of Vascular Surgery, 46(4), 662-668. https://doi.org/10.1016/j.jvs.2007.05.061

Blunt thoracic aortic injury : A single institution comparison of open and endovascular management. / Midgley, Peter I.; MacKenzie, Kent S.; Corriveau, Marc M.; Obrand, Daniel I.; Abraham, Cherrie; Fata, Paola; Steinmetz, Oren K.

In: Journal of Vascular Surgery, Vol. 46, No. 4, 10.2007, p. 662-668.

Research output: Contribution to journalArticle

Midgley, PI, MacKenzie, KS, Corriveau, MM, Obrand, DI, Abraham, C, Fata, P & Steinmetz, OK 2007, 'Blunt thoracic aortic injury: A single institution comparison of open and endovascular management', Journal of Vascular Surgery, vol. 46, no. 4, pp. 662-668. https://doi.org/10.1016/j.jvs.2007.05.061
Midgley, Peter I. ; MacKenzie, Kent S. ; Corriveau, Marc M. ; Obrand, Daniel I. ; Abraham, Cherrie ; Fata, Paola ; Steinmetz, Oren K. / Blunt thoracic aortic injury : A single institution comparison of open and endovascular management. In: Journal of Vascular Surgery. 2007 ; Vol. 46, No. 4. pp. 662-668.
@article{e097eccb94874b3a89d05aba79bda21a,
title = "Blunt thoracic aortic injury: A single institution comparison of open and endovascular management",
abstract = "Objective: To review the treatment of blunt thoracic aortic injuries (BAI) at a single institution over the past 12 years and compare pre-, peri-, and postoperative variables and outcomes of both open (OR) and thoracic endovascular (TEVAR) repair of these injuries. Methods: All cases of confirmed BAI from 1994 to present were included in this retrospective review. Data collected included demographic data, injury severity score, Glasgow coma score, arrival hemodynamic variables, and associated injuries. Operative data included: type of procedure (OR or TEVAR), duration of procedure, need for and amount of blood transfused, use of anticoagulation, type of anesthesia, and service performing the procedure. Outcomes evaluated were: death, paraplegia, length of stay, days ventilated, and procedure related complications. Specific to EVAR; access, stent graft type and number, presence of endoleak and long-term clinical and radiologic follow-up were evaluated. Results: Thirty cases of blunt thoracic aortic injury were identified. Two patients received no treatment and died, 28 patients were treated (OR 16, TEVAR 12) and included for comparison. There were no significant differences between groups with respect to preoperative variables with the exception of significantly more associated intra-abdominal injuries in the TEVAR group (P = .03). Five patients in the OR group (31.2{\%}) died in the perioperative period. There were no deaths in the TEVAR group (P =.05). One OR patient (6.25{\%}) suffered postoperative paraplegia. No paraplegia occurred in the TEVAR group. Intraoperative variables were similar between groups with the exception of mean units of blood transfused (OR 8.5 units, vs TEVAR 0.2 units, P = .002). Ten patients in the OR group either died or had a procedure related complication compared with none in the TEVAR group (P = .001). There was no difference in length of stay or length of mechanical ventilation between the groups. There were no procedure or device related complications in the TEVAR group during follow-up (mean 15.3 months, range 1 to 53.5 months). Conclusions: Endovascular repair of BAI results in significantly less combined mortality and morbidity when compared to OR. Significantly less blood is needed intraoperatively in the TEVAR group. No complications from stent graft insertion have been observed during follow-up. Endovascular repair is replacing open repair as the treatment of choice for BAI at our institution.",
author = "Midgley, {Peter I.} and MacKenzie, {Kent S.} and Corriveau, {Marc M.} and Obrand, {Daniel I.} and Cherrie Abraham and Paola Fata and Steinmetz, {Oren K.}",
year = "2007",
month = "10",
doi = "10.1016/j.jvs.2007.05.061",
language = "English (US)",
volume = "46",
pages = "662--668",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Blunt thoracic aortic injury

T2 - A single institution comparison of open and endovascular management

AU - Midgley, Peter I.

AU - MacKenzie, Kent S.

AU - Corriveau, Marc M.

AU - Obrand, Daniel I.

AU - Abraham, Cherrie

AU - Fata, Paola

AU - Steinmetz, Oren K.

PY - 2007/10

Y1 - 2007/10

N2 - Objective: To review the treatment of blunt thoracic aortic injuries (BAI) at a single institution over the past 12 years and compare pre-, peri-, and postoperative variables and outcomes of both open (OR) and thoracic endovascular (TEVAR) repair of these injuries. Methods: All cases of confirmed BAI from 1994 to present were included in this retrospective review. Data collected included demographic data, injury severity score, Glasgow coma score, arrival hemodynamic variables, and associated injuries. Operative data included: type of procedure (OR or TEVAR), duration of procedure, need for and amount of blood transfused, use of anticoagulation, type of anesthesia, and service performing the procedure. Outcomes evaluated were: death, paraplegia, length of stay, days ventilated, and procedure related complications. Specific to EVAR; access, stent graft type and number, presence of endoleak and long-term clinical and radiologic follow-up were evaluated. Results: Thirty cases of blunt thoracic aortic injury were identified. Two patients received no treatment and died, 28 patients were treated (OR 16, TEVAR 12) and included for comparison. There were no significant differences between groups with respect to preoperative variables with the exception of significantly more associated intra-abdominal injuries in the TEVAR group (P = .03). Five patients in the OR group (31.2%) died in the perioperative period. There were no deaths in the TEVAR group (P =.05). One OR patient (6.25%) suffered postoperative paraplegia. No paraplegia occurred in the TEVAR group. Intraoperative variables were similar between groups with the exception of mean units of blood transfused (OR 8.5 units, vs TEVAR 0.2 units, P = .002). Ten patients in the OR group either died or had a procedure related complication compared with none in the TEVAR group (P = .001). There was no difference in length of stay or length of mechanical ventilation between the groups. There were no procedure or device related complications in the TEVAR group during follow-up (mean 15.3 months, range 1 to 53.5 months). Conclusions: Endovascular repair of BAI results in significantly less combined mortality and morbidity when compared to OR. Significantly less blood is needed intraoperatively in the TEVAR group. No complications from stent graft insertion have been observed during follow-up. Endovascular repair is replacing open repair as the treatment of choice for BAI at our institution.

AB - Objective: To review the treatment of blunt thoracic aortic injuries (BAI) at a single institution over the past 12 years and compare pre-, peri-, and postoperative variables and outcomes of both open (OR) and thoracic endovascular (TEVAR) repair of these injuries. Methods: All cases of confirmed BAI from 1994 to present were included in this retrospective review. Data collected included demographic data, injury severity score, Glasgow coma score, arrival hemodynamic variables, and associated injuries. Operative data included: type of procedure (OR or TEVAR), duration of procedure, need for and amount of blood transfused, use of anticoagulation, type of anesthesia, and service performing the procedure. Outcomes evaluated were: death, paraplegia, length of stay, days ventilated, and procedure related complications. Specific to EVAR; access, stent graft type and number, presence of endoleak and long-term clinical and radiologic follow-up were evaluated. Results: Thirty cases of blunt thoracic aortic injury were identified. Two patients received no treatment and died, 28 patients were treated (OR 16, TEVAR 12) and included for comparison. There were no significant differences between groups with respect to preoperative variables with the exception of significantly more associated intra-abdominal injuries in the TEVAR group (P = .03). Five patients in the OR group (31.2%) died in the perioperative period. There were no deaths in the TEVAR group (P =.05). One OR patient (6.25%) suffered postoperative paraplegia. No paraplegia occurred in the TEVAR group. Intraoperative variables were similar between groups with the exception of mean units of blood transfused (OR 8.5 units, vs TEVAR 0.2 units, P = .002). Ten patients in the OR group either died or had a procedure related complication compared with none in the TEVAR group (P = .001). There was no difference in length of stay or length of mechanical ventilation between the groups. There were no procedure or device related complications in the TEVAR group during follow-up (mean 15.3 months, range 1 to 53.5 months). Conclusions: Endovascular repair of BAI results in significantly less combined mortality and morbidity when compared to OR. Significantly less blood is needed intraoperatively in the TEVAR group. No complications from stent graft insertion have been observed during follow-up. Endovascular repair is replacing open repair as the treatment of choice for BAI at our institution.

UR - http://www.scopus.com/inward/record.url?scp=34548856474&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548856474&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2007.05.061

DO - 10.1016/j.jvs.2007.05.061

M3 - Article

C2 - 17764869

AN - SCOPUS:34548856474

VL - 46

SP - 662

EP - 668

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 4

ER -