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Dramatic Shift in the Primary Management of Traumatic Thoracic Aortic Rupture
Darren R. Lebl, MD;
Rochelle A. Dicker, MD;
David A. Spain, MD;
Susan I. Brundage, MD, MPH
Arch Surg. 2006;141:177-180.
Hypothesis Traumatic thoracic aortic injury (TAI) is traditionally treated with immediate surgery. Previously published studies have established the safety and efficacy of treating TAI with endovascular stents. Our hypothesis was that stents are supplanting operative repair as the primary therapy for TAI.
Design Retrospective cohort.
Setting University level I trauma center.
Patients and Methods Blunt trauma patients admitted to a level I trauma center diagnosed with TAI between September 1997 and November 2003 were identified from an institutional trauma registry (N = 25). Data were abstracted from medical records and analyzed. Three groups were defined: surgical repair (cardiopulmonary bypass or clamp and sew) (n = 10); medical management (n = 8); and endovascular stent (n = 7).
Results Prior to 2002, 9 (75%) of 12 patients were treated by surgical repair, 2 (17%) by medical management, and 1 (8%) by endovascular stent. Since 2002, 1 patient (8%) was treated by surgical repair, 6 (46%) by medical management, and 6 (46%) by endovascular stent. Injury Severity Scores were comparable between the surgical cohort (mean ± SEM score, 34.9 ± 3.4), stent placement (35.1 ± 3.7), and medical management (29.9 ± 2.8) (P = .48). Overall survival was 80% with no differences in morbidity or mortality. The stented group had shorter hospital lengths of stay compared with surgical management (28 vs 46 days) (P<.05). The 1 operative case since 2002 was a combined arch/innominate injury that anatomically precluded stent placement.
Conclusion Initial reports suggested thoracic aortic stents as an alternative for injured patients with prohibitive operative risks. Our data suggest stent placement is quickly evolving into the primary therapy for TAI across all Injury Severity Score profiles.
Author Affiliations: Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Stanford University Medical Center, Stanford, Calif (Drs Lebl, Dicker, Spain, and Brundage).
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