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Background: To compare conventional open repair of acute blunt aortic injury of the proximal descending thoracic aorta to endovascular repair with stents.
Methods: A retrospective chart review was performed on all open procedures treating blunt aortic injury. A prospective database was established for the endovascular treatment of blunt aortic injury and utilized for the comparison group. The two groups were compared using Fisher’s Exact and/or Wilcoxon tests.
Results: The study population spans 1999-2011 with 35 open procedures utilizing left thoracotomy, partial bypass and segmental replacement of the descending thoracic aorta and 40 thoracic endovascular aortic repairs (TEVAR) utilizing 6 different commercially available stents from a primarily femoral artery approach. Ages of patients ranged from 12 to 84 (mean 41) with >80% male. Immediate successful coverage of the aortic tear was accomplished in 37/40 of the TEVAR cases with ultimate success in 39/40. The left subclavian artery was covered with a stent in 10/40 TEVAR cases and IVUS was utilized in 24/40 cases. Comparing the open experience to TEVAR, we found no difference with respect to age (42 vs. 39), Injury Severity Score (42 vs 43), ICU stay (19 vs. 18) overall length of stay (25 vs. 35) and complications including death (not shown). However, we did note significant differences comparing the open to the TEVAR group with respect to time from admission to treatment, procedure time and intraoperative blood transfusions (Table I). We have seen no late endoleaks, stent migration or any stent related complications in follow up (mean f/u 26 mos).
Table I

	Open (35)	TEVAR (40)	P value
Admit to OR (hrs)	21	57	0.02
Procedure time (hrs)	5.9	3.5	<0.001
Intraop Blood Transfusions (units)	9.1	1.4	<0.001

Conclusion: TEVAR is a safe and effective method of treating BAI with excellent short and mid-term results. Our experience is unique by employing 6 different commercially available stents and covering the left subclavian artery 25% of the time. We believe that IVUS can be critical to the intraoperative treatment approach and now use it routinely. TEVAR confers several advantages over traditional open repair and is our preferred, front-line approach.