Outcome of endovascular stent grafting versus open surgical repair in traumatic thoracic aortic injury

BACKGROUND: In 1994 Dake et al. first reported the use of thoracic "stent-grafts" for the treatment of descending thoracic aortic aneurysms in patients who were believed to be at excessive risk for conventional open surgery. Later they showed thoracic endovascular aneurysm repair (TEVAR) could be performed from a technical standpoint in patients with descending thoracic aortic dissections (patients with tears in the wall of their aortas). Nonetheless, ongoing studies are still trying to identify which patients with thoracic aortic dissection can benefit from TEVAR. The aim of this work was to evaluate the beneficial role of TEVAR in management of patients with traumatic aortic dissection. METHODS : This is a retrospective study that included 64 patients; of them 32 patients were subjected to traumatic thoracic aortic dissection, either isolated or along with other injuries, in the period between October 2014 and May 2017, and this dissection was managed by TEVAR technique (group A) and these patients were compared with another 32 patients that had traumatic thoracic aortic dissection and were managed by the conventional open surgery in earlier period (group B). Patients were compared as regards; length of hospital stay, perioperative complications, postoperative mechanical ventilation period, ICU stay, postoperative complications including mortality, need for blood transfusion, and re-intervention. RESULTS: Retrospective analysis of data from both groups showed a significant decrease in hospital stay (mean days 8.2 in group A vs. 15.5 in group B), ICU stay (mean days 1.9 vs. 2.9), need for postprocedure mechanical ventilation (mean hours 3.8 vs. 28), units of packed red blood cells transfused (mean 0.44 vs. 2.5) and significant decrease in post-operative complications in group A. CONCLUSIONS: TEVAR is a minimally invasive procedure that is alternative to major open surgery for the repair of traumatic thoracic aortic injury that results in reduced recovery times and potentially improved survival rates.