BACKGROUND: To evaluate outcome differences in open surgical and endovascular treatment of traumatic aortic rupture (TAR) over a period of 30 years. METHODS: We retrospectively reviewed the diagnostic workup and management of all patients and compared outcome before and since the era of endovascular therapy. RESULTS: Between 1980 and 2010, 72 patients with a mean age of 38 years (range, 14-76) were treated for TAR. Of these, 48 (67%) were treated by open surgery and the remaining 24 (33%) by thoracic endovascular aortic repair (TEVAR). In the open surgery group, mortality was 16.7% and paraplegia occurred in 8.3% of patients, whereas mortality was 4.2% and no paraplegia occurred in the TEVAR group. Diagnostic workup consisted of chest X-ray and arteriography in the early period, whereas computed tomographic scan and transesophageal echography were preferred in the more recent period. CONCLUSIONS: Although our results could not reach statistical significance, mainly because of the gross oversizing of the open group in comparison with the TEVAR group, TEVAR has introduced a less invasive era in the treatment of TAR and has become the therapy of choice. The diagnostic workup has evolved from chest X-ray and arteriography to computed tomographic scanning and even transesophageal echography.
BACKGROUND: To evaluate outcome differences in open surgical and endovascular treatment of traumatic aortic rupture (TAR) over a period of 30 years. METHODS: We retrospectively reviewed the diagnostic workup and management of all patients and compared outcome before and since the era of endovascular therapy. RESULTS: Between 1980 and 2010, 72 patients with a mean age of 38 years (range, 14-76) were treated for TAR. Of these, 48 (67%) were treated by open surgery and the remaining 24 (33%) by thoracic endovascular aortic repair (TEVAR). In the open surgery group, mortality was 16.7% and paraplegia occurred in 8.3% of patients, whereas mortality was 4.2% and no paraplegia occurred in the TEVAR group. Diagnostic workup consisted of chest X-ray and arteriography in the early period, whereas computed tomographic scan and transesophageal echography were preferred in the more recent period. CONCLUSIONS: Although our results could not reach statistical significance, mainly because of the gross oversizing of the open group in comparison with the TEVAR group, TEVAR has introduced a less invasive era in the treatment of TAR and has become the therapy of choice. The diagnostic workup has evolved from chest X-ray and arteriography to computed tomographic scanning and even transesophageal echography.
Authors: Dennis Hundersmarck; Quirine M J van der Vliet; Lotte M Winterink; Luke P H Leenen; Joost A van Herwaarden; Constantijn E V B Hazenberg; Falco Hietbrink Journal: Eur J Trauma Emerg Surg Date: 2020-07-06 Impact factor: 2.374