TEVAR effective for severe blunt traumatic aortic injury in older adults

Thoracic endovascular aortic repair (TEVAR) is an effective treatment approach for blunt traumatic aortic injury (BTAI) in older or severely injured patients, a recent study has found. Meanwhile, open repair is a viable and important alternative for younger patients or those with unsuitable aortic anatomies.

Researchers conducted a retrospective chart review of 42 BTAI patients (median age 49 years, 92.5 percent men), of whom 17 were treated with TEVAR, 16 with open surgical repair, and seven with medical management. Outcomes such as mortality and hospital stay were compared among groups, as were baseline demographic, injury, and procedural characteristics.

TEVAR patients were significantly older than comparators who underwent open repair (median, 55 vs 43 years; p=0.002) and had significantly larger aorta size (median, 24.07 vs 22.37 mm; p=0.001). In contrast, the TEVAR procedure took significantly less time than open repair (median, 76 vs 337.5 mins; p=0.000).

In terms of outcomes, 75 percent (n=12) of patients in the open repair group were discharged to a rehabilitation facility, while the rest (n=4; 25 percent) were discharged to their homes. No deaths were recorded, but two patients developed vocal cord palsy and one had postoperative paraplegia.

In comparison, two patients died in the TEVAR group. One death occurred within 48 hours of hospitalization, before the procedure, and was thus deemed unrelated to TEVAR. The other death was due to multiorgan failure caused by pneumonia and sepsis 31 days postoperatively. As in the open repair group, majority (88 percent; n=15) of TEVAR patients were discharged to rehabilitation facilities.

One patient in the medical management subgroup died, and the cause was identified to be severe head injury.