Contemporary management and outcomes of blunt thoracic aortic injury: A multicenter retrospective study

Abstract

Background: Blunt Thorac. Aortic Injuries Are Composed of A Spectrum of Lesions Ranging from Intimal Tear to Rupture, Yet Optimal Mgmt. and Ultimate Outcome Have Not Been Clearly Estab.. Methods: This is A Retrospective Multicenter Stud. of BTAis from January 2008 to December 2013. Demographics, Diagn., Treatm., and In-Hosp. Outcomes Were Analyzed. Results: Nine Amer. Coll. of Surgs.-verified Level i Trauma Centers Contributed Data from 453 Patients with BTAIs. after Exclusion of Patients Expiring before Imaging and Transfers , 382 Patients with Imaging Diagn. Were Available for Anal. . Hypotension Was Present on Admission in 56 . Computed Tomographic Angiography Was Used for Diagn. in 94.5%. Nonoperative Mgmt. Was Selected in 32%, with Two In-Hosp. Failures Requiring Endovascular Salvage . Open Repair Was Completed in 61 . TEVAR Was Conducted in 198 , with 41% of These Requiring Left Subclavian Artery Coverage. Complications of TEVAR Included Endograft Malposition , Endoleak , Paralysis , and Stroke . Six TEVAR Failures Were Treated by Repeat TEVAR or or . Overall In-Hosp. Mortality Was 18.8%, and Aortic-related Mortality Was 6.5% . the Majority of Aortic-related Deaths Occurred before the Opportunity for Repair. Ind. Predictors of Aortic-related Mortality among BTAi Patients Were Higher Chest Abbreviated Inj. Scale Score, Grade, and Inj. Severity Score ; TEVAR Was Protective . Conclusion: Failures and Aortic-related Mortality of NOM Following BTAi Soc. of Vasc. Surg. Grade 1 to 3 Injuries Are Rare. TEVAR Seems Independently Protective Against Aortic-related Mortality. Early Complications of TEVAR Have Decreased Relative to Previous Reports. Prospective Long-term Follow-up Data Are Required to Better Refine Indications for Intervention. Level of Evidence: Level IV.