Abstract
Thoracic endovascular aortic repair (TEVAR) has been adopted rapidly for treating traumatic thoracic aortic injury (TAI). The long-term durability and efficacy remain unknown. To determine the long-term outcomes of thoracic endovascular aortic repair and those of open repair (OR) for traumatic TAI. This nationwide cohort study used Taiwan's National Health Insurance Database to evaluate patients with traumatic TAI between January 1, 2004, and December 31, 2013. This single-payer National Health Insurance program covered more than 99.9% of the Taiwanese population. Those who received OR or TEVAR for TAI by propensity score matching were included. Data analysis was conducted in October 2017. Thoracic endovascular aortic repair vs open repair. In-hospital outcomes, all-cause mortality, aorta reintervention, and stroke during follow-up. Of the 287 patients (mean [SD] age, 41.66 [17.98] years; 80.5% male) who received OR or TEVAR for TAI, propensity score matching yielded 100 patients each in the OR and TEVAR groups. After propensity score matching, in-hospital mortality risk was significantly lower in the TEVAR group (9 [9.0%]) than in the OR group (27 [27.0%]; TEVAR vs open repair: odds ratio, 0.27; 95% CI, 0.12-0.60). With a mean (SD) follow-up of 2.80 (2.63) years, the proportion of survivors was 71.9% at 1 year, 70.8% at 2 years, 68.2% at 3 years, and 65.1% at 5 years in the OR group vs 88.9% at 1 year, 88.9% at 2 years, 88.9% at 3 years, and 88.9% at 5 years in the TEVAR group (log-rank test, P < .001). The TEVAR group had only 2 events (2%) of late reintervention and 1 event (1%) of late cerebrovascular accident. The proportion of freedom from reintervention was 100% at 1 year, 100% at 2 years, 100% at 3 years, and 100% at 5 years in the OR group vs 97.4% at 1 year, 97.4% at 2 years, 97.4% at 3 years, and 97.4% at 5 years in the TEVAR group (log-rank test, P = .18). Compared with OR, TEVAR was associated with better long-term outcomes, mainly owing to lower mortality during the perioperative period. In addition, TEVAR was associated with a similar rate of survival and reintervention after hospital discharge.
Highlights
Traumatic thoracic aortic injury (TAI) is the second-leading cause of death among trauma patients.[1,2] Baker et al[3] and Trunkey[4] defined the timing of trauma deaths as a trimodal distribution in urban environments in the United States; the distribution of death after traumatic injury can be characterized by 3 periods
In-hospital mortality risk was significantly lower in the Thoracic endovascular aortic repair (TEVAR) group (9 [9.0%]) than in the OR group (27 [27.0%]; TEVAR vs open repair: odds ratio, 0.27; 95% CI, 0.120.60)
Meaning This study suggests that thoracic endovascular aortic repair may be more suitable than open repair for patients with traumatic thoracic aortic injury
Summary
Traumatic thoracic aortic injury (TAI) is the second-leading cause of death among trauma patients.[1,2] Baker et al[3] and Trunkey[4] defined the timing of trauma deaths as a trimodal distribution in urban environments in the United States; the distribution of death after traumatic injury can be characterized by 3 periods. The remaining 20% of deaths occurs late (weeks), secondary to sepsis or multiple organ failure. Endovascular repair with a stent graft was introduced in the late 1990s. Endovascular repair of isolated descending thoracic aneurysms was approved by the US Food and Drug Administration in 2005.6 The indications of use were expanded to include traumatic aortic transection by the US Food and Drug Administration in 2012
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