Injury of the thoracic aorta after blunt trauma: Radiological evaluation and management
Background: Blunt traumatic thoracic aortic injury is a life-threatening event. The traditional management of these patients has been immediate open surgical repair, often associated with high perioperative mortality. In recent years endovascular repair has emerged as a less invasive and potentially safer alternative.
Methods: The current literature on traumatic thoracic aortic injury was review and a systematic review of publications comparing endovascular and open treatment was undertaken. Relevant articles were searched using Pubmed. In the systematic review papers reporting clinical series with one group of adult patients treated by endovascular repair and another group treated by open repair were identified.
Results: 11 publication and 314 patients were included in the systematic review. 123 (39%) were treated by endovascular repair and 191 (61%) underwent open surgical repair. There were no significant differences in demographics, but the mean injury severity score was significantly higher in the endovascular group. 11 patients (9%) in the endovascular group and 32 patients (17%) in the open surgical group died within 30 days of repair. The intraoperative mortality was 0,9% and 9,6% respectively. The differences in mortality reached statistic significance (p<0,05). There were 33 (28%) registered complications during the hospital stay in the endovascular group and 74 (44%) in the open surgical group. Postoperative paraplegia was observed in 12 patients after open surgical repair. There were no cases of paraplegia in the endovascular group.
Conclusion: In the reviewed literature, there is a clear trend towards better immediate outcomes after endovascular repair compared with standard open repair for traumatic thoracic aortic injury. However, the long-term results of endovascular repair remain unknown.