TEVAR is Superior to Open Repair for Blunt Aortic Injury

TEVAR is Superior to Open Repair for Blunt Aortic Injury

Royce Calhoun, MD, Stephanie Mayberg, PA-C, Bill Pevec, MD, Danh Nguyen, PhD^, Lisa Mu^

J. Nilas Young, MD John Laird, MDo

Division of Cardiothoracic SurgeryoDivision of Cardiology

^Department of BiostatisticsUniversity of California Davis Medical Center

Royce Calhoun, MD, Stephanie Mayberg, PA-C, Bill Pevec, MD, Danh Nguyen, PhD^, Lisa Mu^

J. Nilas Young, MD John Laird, MDo

Division of Cardiothoracic SurgeryoDivision of Cardiology

^Department of BiostatisticsUniversity of California Davis Medical Center

Blunt Aortic InjuryBlunt Aortic Injury

• 75% patients die at scene of accident

• 5% are unstable and die shortly after accident

• 25% of remainder die of other injuries

• Traditional approach to repair has been emergent open repair- Paraplegia 2-19%, Mortality 15-35%

• Current trend is appropriately timed urgent repair with an evolving endovascular role - Paraplegia 0%, Mortality 0-17%

• 75% patients die at scene of accident

• 5% are unstable and die shortly after accident

• 25% of remainder die of other injuries

• Traditional approach to repair has been emergent open repair- Paraplegia 2-19%, Mortality 15-35%

• Current trend is appropriately timed urgent repair with an evolving endovascular role - Paraplegia 0%, Mortality 0-17%

MethodsMethods

• Comparison of open repair vs. stent for TTAT

• 1999 to 2011

• First thoracic aortic stent was October 2005

• Exclusively stent repair for last 4 years

• Comparison of open repair vs. stent for TTAT

• 1999 to 2011

• First thoracic aortic stent was October 2005

• Exclusively stent repair for last 4 years

ApproachApproach

• Open

- n=35

- Thoracotomy, L groin 30

- Partial bypass 24

- Full bypass 7

- DHCA 4

- Thoracotomy, Gott shunt 1

• Open

- n=35

- Thoracotomy, L groin 30

- Partial bypass 24

- Full bypass 7

- DHCA 4

- Thoracotomy, Gott shunt 1

• Endograft

- n=40

- Femoral (cut down) 33

- Iliac (RP with graft) 2

- Infrarenal Aorta (4 RP, 1 Lap) 5

• Endograft

- n=40

- Femoral (cut down) 33

- Iliac (RP with graft) 2

- Infrarenal Aorta (4 RP, 1 Lap) 5

Stent Graft ResultsStent Graft Results

• Stents Used- 7 TAG - 1 C-TAG- 17 Excluder Cuffs - 4 AneuRx Cuffs - 2 Talent - 9 TX2

• 36/40 immediate technical success

• 39/40technical success after re-interventions

• Complete coverage of traumatic tear with no stent migration or endoleaks at most recent follow-up

• Stents Used- 7 TAG - 1 C-TAG- 17 Excluder Cuffs - 4 AneuRx Cuffs - 2 Talent - 9 TX2

• 36/40 immediate technical success

• 39/40technical success after re-interventions

• Complete coverage of traumatic tear with no stent migration or endoleaks at most recent follow-up

CaseCase

• 17 YO male, ejected from car

• Intracranial bleed, multiple orthopedic injuries, splenic and liver lacerations

• Bilateral severe pulmonary contusions

• pO2 55 on 100% FIO2 with 20 PEEP

• Comminuted aortic tear

• 17 YO male, ejected from car

• Intracranial bleed, multiple orthopedic injuries, splenic and liver lacerations

• Bilateral severe pulmonary contusions

• pO2 55 on 100% FIO2 with 20 PEEP

• Comminuted aortic tear

ResultsResults

Endograft Open p

Patients 40 (33 male) 35 (30 male)

Age 39 42 0.52

ISS 43 42 0.67

Admit to OR (hrs)

57 22 <0.01

Procedure time (hrs)

3.5 5.9 <0.01

ResultsResults

Endograft Open p

Transfusions 1.9 9.1 <0.01

ICU (days) 19 18 0.61

Ventilator

(median days)

13 28 0.14

LOS (days) 35 35 0.95

F/U (mos) 23 18

Major Adverse EventsMajor Adverse Events

Endograft

n=40

Open

n=35

Death 3 7

Paraplegia 0 0

CVA 0 0

Renal Failure requiring dialysis

2 4

Subclavian Steal 2 0

Vascular Access 1 3

Re-intervention/re-op 6 5

ConclusionsConclusions• Endovascular stents for BAI can be

performed safely with excellent short and mid-term results

• Time from admission to intervention of BAI is increased in the stent group with no increased mortality

• Stents for BAI are associated with decreased OR times and intraoperative blood transfusions compared to open

• Endovascular stents for BAI can be performed safely with excellent short and mid-term results

• Time from admission to intervention of BAI is increased in the stent group with no increased mortality

• Stents for BAI are associated with decreased OR times and intraoperative blood transfusions compared to open