Regarding “Late outcomes following open and endovascular repair of blunt thoracic aortic injury”

Abstract

I applaud Patel and colleagues for an informative and well-written article on late outcomes associated with repair of blunt thoracic aortic injury.1Patel H.J. Hemmila M.R. Williams D.M. Diener A.C. Deeb G.M. Late outcomes following open and endovascular repair of blunt thoracic aortic injury.J Vasc Surg. 2011; 53: 615-621Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar However, the evaluation of late mortality—the stated primary end point of the trial—is notably missing for each treatment group. Instead, the results of both treatment groups are presented collectively in Fig 1, a. This data presentation is confusing because: (1) mean follow-up was nearly 10 years with open surgical repair vs only 3 years with endovascular repair and, (2) open surgical repair patients comprised 83% (90 of 109) of the entire cohort. These factors strongly influence the overall survival estimate (especially with longer follow-up) to approximate that of open surgical repair. Despite the small number of patients treated with endovascular repair in this study (n = 19), it would be of great interest to see the long-term survival rate in this group reported separately. Late outcomes following open and endovascular repair of blunt thoracic aortic injuryJournal of Vascular SurgeryVol. 53Issue 3PreviewPrevious studies have focused on early outcomes of open (descending thoracic aortic repair [DTAR]) and endovascular (thoracic endovascular aneurysm repair [TEVAR]) repair of blunt aortic injury (blunt thoracic aortic injury [BTAI]). Late results remain ill-defined and are the focus of this study. Full-Text PDF Open ArchiveReplyJournal of Vascular SurgeryVol. 53Issue 6PreviewWe appreciate Dr Miller's comments regarding our work on late outcomes after repair of traumatic aortic injury.1 We agree that in the analysis of the entire cohort, the weight of the open descending thoracic aortic repair (DTAR) group will statistically influence late survival of the cohort for the reasons he stated. The type of repair was not associated with the primary endpoint of late mortality rate (DTAR 15.6% vs thoracic endovascular aneurysm repair [TEVAR] 10.5%; P = .73). The Kaplan-Meier curves stratified by type of repair are shown below (Fig) and confirm that there is no time dependency of this mortality rate. Full-Text PDF Open Archive