Diagnosis and Treatment of Blunt Thoracic Aortic Injuries: Changing Perspectives

• DOI: 10.1097/ta.0b013e3181715e32
• Publication Date: 2009-03-05T18:02:41Z
• Authors: Demetrios Demetri...; George C. Velmahos; Thomas M. Scalea; Gregory J. Jurkovich; Riyad Karmy-Jones; Pedro G. Teixeira; Mark R. Hemmila; James V. O’Connor; Mark O. McKenney; Forrest O. Moore; Jason London; Michael J. Singh; Konstantinos Span...; Marius Keel; Michael Sugrue; Wendy L. Wahl; Jonathan Hill; Mathew J. Wall; Ernest E. Moore; Edward Lineen; Daniel Margulies; Valerie Malka; Linda S. Chan
• Keywords: Aortography; Paraplegia; Cardiothoracic surgery; Aortic repair

Background: The diagnosis and management of blunt thoracic aortic injuries has undergone many significant changes over the last decade. present study compares clinical practices results between an earlier prospective multicenter by American Association for Surgery Trauma completed in 1997 (AAST1) a new similar 2007 (AAST2). Methods: AAST1 included 274 patients from 50 participating centers period 30 months. AAST2 193 18 centers, 26 comparisons two studies method definitive injury [computed tomography (CT) scan, aortography, transesophageal echocardiogram (TEE) or magnetic resonance imaging], repair (open vs. endovascular repair, clamp sew bypass techniques), time to procedure (early delayed repair), outcomes (survival, procedure-related paraplegia, other complications). Results: There was major shift injury, aortography CT scan AAST2, nearly complete elimination TEE study. In made 93.3%, 8.3%, 1.0% when compared with 34.8%, 87.0%, 11.9%, respectively, (p < 0.001). mean increased 16.5 hours 54.6 study, all were managed open whereas only 35.2% remaining 64.8% stent-grafts. use techniques 64.7% 83.8%. overall mortality, excluding extremis, decreased significantly 22.0% 13.0% = 0.02). Also, incidence paraplegia planned operation, 8.7% 1.6% However, early graft-related complications 0.5% 18.4% Conclusions: Comparison AAST showed widespread almost TEE. concept gained wide acceptance. Endovascular replaced great extent. These have resulted reduction mortality but also increase complications.