Endovascular repair versus open repair for blunt traumatic aortic injury
Ohchoon Kwon1, Sub Lee1, Jun Woo Cho1, Nam Hee Park2, Keun Jik Kim3.
1Daegu catholic univ. hospital, Daegu, Korea, Republic of, 2Dongsan Medical Center, Daegu, Korea, Republic of, 3Kyungbuk National University Hospital, Daegu, Korea, Republic of.
OBJECTIVE: Blunt traumatic aortic injury(BTAI) is a rare disease, but its mortality has been reported to be as high as over 80%. Open repair has been established as the standard treatment for BTAI, however, endovascular repair is preferred in many medical centers after the introduction of endovascular stent grafting.
METHODS: The retrospective study was performed from March 2003 to August 2012 for the patients with BTAI. The endovascular repair was started from 2008 in our center. We analyzed the differences between the open repair group and endovascular repair group in terms of age, sex, time to procedure, injury severity score(ISS), dosage of heparin, bleeding volume, transfusion volume, period of ICU stay, period of hospital stay, and mortality.
RESULTS: A total of 30 patients(17 male) with the descending thoracic aorta injured by blunt trauma were treated. Among them, 11 patients were treated by open repair(OR) and, 19 patients were treated by endovascular repair(ER). The mean ages of the open repair group and endovascular repair group were 43.19 and 49.47, respectively(p=0.374). There was no statistical difference between the two groups in time to procedure(OR 95.9hr vs ER 74.89hr) or ISS(OR 26.27 vs ER 26.11). Dosage of heparin(OR 22181.82units vs ER 2894.74units, p<0.000), bleeding volume(OR 2045.45ml vs ER 252.63ml, p<0.000), and transfusion volume(OR 14units vs ER 2.42units, p<0.000) were statistically different between the two groups, but the period of ICU stay and hospital stay were not different. The endovascular repair group showed better results for mortality(open repair 18.8% vs endovascular repair 0%), but there was no statistical difference.
CONCLUSIONS: Although statistically no significant different mortality existed between the two groups, there was a tendency toward lower mortality in the endovascular group. Endovascular repair with lesser blood loss and transfusion volume can be used in BTAI over open repair, but the conformational changes of endovascular stent must be followed with these relatively younger aged patients.
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