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Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury.

Publication ,  Journal Article
Jonker, FHW; Giacovelli, JK; Muhs, BE; Sosa, JA; Indes, JE
Published in: Journal of vascular surgery
March 2010

Traumatic thoracic aortic injury (TTAI) is associated with high mortality rates. Data supporting thoracic endovascular aortic repair (TEVAR) to reduce mortality and morbidity for TTAI is limited to small series and meta-analyses. In this study, we evaluated the trends and outcomes of open surgery and TEVAR for TTAI in New York State.All cases of TTAI in New York State between 2000 and 2007 were extracted from the New York Statewide Planning and Research Cooperative System (SPARCS) database. A diagnosis by International Classification of Diseases, 9th Revision coding of TTAI was required for inclusion.We identified 328 patients with TTAI who underwent surgical repair in New York State between 2000 and 2007; mean age of the cohort was 39.3 years +/- 18 years; 80% were male. Open repair of TTAI was performed in 79.6% and 20.4% underwent TEVAR. Open repair was performed for all cases of TTAI until the introduction of TEVAR in 2005; TEVAR exceeded the use of open repair for TTAI in 2006 and 2007. Additional major injuries were present in 71.7% in the open repair group vs 91.0% of the TEVAR group (P = .001). The overall in-hospital mortality rate for the 8-year period was significantly increased after open repair of TTAI compared with TEVAR: 17% vs 6%, (odds ratio [OR] 3.19, 95% confidence interval [CI], 1.11-9.23; P = .024). After controlling for the significant covariates, TEVAR independently reduced the risk of death following surgical intervention for TTAI compared with the open procedure (OR 3.8, 95% CI, 1.28-10.99; P = .010). Respiratory complications were the most common postoperative morbidity, and were significantly increased after open repair: 38% vs 24% (OR 1.95; 95% CI, 1.05-3.60; P = .032). There were no significant differences in cardiac complications, acute renal failure (ARF), paraplegia, or stroke. Endoleak and distal embolization each occurred in 9% of patients after TEVAR.There has been a shift toward endovascular management of patients with TTAI. This change in surgical strategy has been associated with less postoperative mortality and fewer pulmonary complications in patients suffering from TTAI. TEVAR is associated with significant device-related complications.

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Published In

Journal of vascular surgery

DOI

EISSN

1097-6809

ISSN

0741-5214

Publication Date

March 2010

Volume

51

Issue

3

Start / End Page

565 / 571

Related Subject Headings

  • Young Adult
  • Wounds and Injuries
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • New York
  • Middle Aged
  • Male
 

Citation

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Chicago
ICMJE
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Jonker, F. H. W., Giacovelli, J. K., Muhs, B. E., Sosa, J. A., & Indes, J. E. (2010). Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury. Journal of Vascular Surgery, 51(3), 565–571. https://doi.org/10.1016/j.jvs.2009.10.046
Jonker, Frederik H. W., Jeannine K. Giacovelli, Bart E. Muhs, Julie Ann Sosa, and Jeffrey E. Indes. “Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury.Journal of Vascular Surgery 51, no. 3 (March 2010): 565–71. https://doi.org/10.1016/j.jvs.2009.10.046.
Jonker FHW, Giacovelli JK, Muhs BE, Sosa JA, Indes JE. Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury. Journal of vascular surgery. 2010 Mar;51(3):565–71.
Jonker, Frederik H. W., et al. “Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury.Journal of Vascular Surgery, vol. 51, no. 3, Mar. 2010, pp. 565–71. Epmc, doi:10.1016/j.jvs.2009.10.046.
Jonker FHW, Giacovelli JK, Muhs BE, Sosa JA, Indes JE. Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury. Journal of vascular surgery. 2010 Mar;51(3):565–571.
Journal cover image

Published In

Journal of vascular surgery

DOI

EISSN

1097-6809

ISSN

0741-5214

Publication Date

March 2010

Volume

51

Issue

3

Start / End Page

565 / 571

Related Subject Headings

  • Young Adult
  • Wounds and Injuries
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • New York
  • Middle Aged
  • Male