Thoracic Endovascular Aortic repair for Traumatic Aortic Aneurysms: 6-year Single Center Experience
Collins, Briana
Collins, Briana
Citations
Altmetric:
Soloist
Composer
Publisher
Date
5/1/2023
Additional date(s)
Abstract
Hypothesis: TEVAR can be performed safely and effectively without significant morbidity and mortality at a community-based level one trauma center. The purpose of this study is to evaluate perioperative outcomes of thoracic endovascular repair (TEVAR) to treat blunt thoracic aortic injury over a 6-year period at single center (Baylor University Medical Center). Background/Intro: Trauma is the leading cause of death in young adults up to age 45 years. Head injury is the most prevalent blunt traumatic injury followed by aortic injury. The most common mechanism of aortic injury is motor vehicle collisions. Aortic injuries carry a high fatality rate with up to 80% dying at the scene. Thoracic endovascular repair has been the mainstay of treatment for these injuries versus open surgical repair. TEVAR has been associated with less morbidity and mortality but is not without its own complications, specifically ischemic-related events. We present a single-center experience from a quaternary care surgical center.
Materials and Methods: The records of the patients who underwent thoracic endovascular repair (TEVAR) between October 2015 to November 2021 for traumatic aortic injuries were evaluated. 28 patients were treated with TEVAR for BTAI at Baylor University Medical Center (BUMC) in Dallas, Texas. Perioperative data was collected retrospectively from patients’ charts. Additionally, data was accessed from the Vascular Quality Initiative (VQI) Registry at BUMC. Patients who underwent open repair were not included.
Results: 28 patients underwent thoracic endovascular repair (TEVAR) for blunt thoracic aortic injury (BTAI). There were 20 men (71.4%) and 8 women (28.6%) with a mean patient age of 42.3 years (range, 14-85). The most common mechanism of injury was motor vehicle accidents (n=26, 92.8%), followed by fall (n=1, 3.6%) and penetrating injury (n=1, 3.6%). There was no reported procedure related in-hospital deaths, spinal ischemia, or paraplegia. Nine (32.1%) patients had post-operative complications. Two (7.1%) patients developed a new arrythmia, both treated medically. Three patients (10.7%) had ischemia-related complications: leg embolism, carotid artery stroke, and intestinal ischemia. Multiple patient specific risk factors were analyzed for their association with the incidence of complications. Neither gender (p=0.44), race (p=1), smoking history (p=0.70), or related comorbidities like hypertension (p=0.36) and diabetes mellitus (p=0.19) were statistically significant for complication risk in our study population.
Conclusion: Traumatic aortic injury is rare but highly fatal. TEVAR is associated with decreased morbidity and mortality compared to open surgical repair. Risk factors for ischemic-related complications continue to be an area of interest as well as long-term outcomes.
Materials and Methods: The records of the patients who underwent thoracic endovascular repair (TEVAR) between October 2015 to November 2021 for traumatic aortic injuries were evaluated. 28 patients were treated with TEVAR for BTAI at Baylor University Medical Center (BUMC) in Dallas, Texas. Perioperative data was collected retrospectively from patients’ charts. Additionally, data was accessed from the Vascular Quality Initiative (VQI) Registry at BUMC. Patients who underwent open repair were not included.
Results: 28 patients underwent thoracic endovascular repair (TEVAR) for blunt thoracic aortic injury (BTAI). There were 20 men (71.4%) and 8 women (28.6%) with a mean patient age of 42.3 years (range, 14-85). The most common mechanism of injury was motor vehicle accidents (n=26, 92.8%), followed by fall (n=1, 3.6%) and penetrating injury (n=1, 3.6%). There was no reported procedure related in-hospital deaths, spinal ischemia, or paraplegia. Nine (32.1%) patients had post-operative complications. Two (7.1%) patients developed a new arrythmia, both treated medically. Three patients (10.7%) had ischemia-related complications: leg embolism, carotid artery stroke, and intestinal ischemia. Multiple patient specific risk factors were analyzed for their association with the incidence of complications. Neither gender (p=0.44), race (p=1), smoking history (p=0.70), or related comorbidities like hypertension (p=0.36) and diabetes mellitus (p=0.19) were statistically significant for complication risk in our study population.
Conclusion: Traumatic aortic injury is rare but highly fatal. TEVAR is associated with decreased morbidity and mortality compared to open surgical repair. Risk factors for ischemic-related complications continue to be an area of interest as well as long-term outcomes.
Contents
Subject
Subject(s)
Research Projects
Organizational Units
Journal Issue
Genre
Description
Format
Department
Burnett School of Medicine