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TEVAR is Superior to Open Repair for Blunt Aortic Injury. Royce Calhoun, MD, Stephanie Mayberg, PA-C, Bill Pevec, MD, Danh Nguyen, PhD^, Lisa Mu^ J. Nilas Young, MD John Laird, MD o Division of Cardiothoracic Surgery o Division of Cardiology ^Department of Biostatistics

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tevar is superior to open repair for blunt aortic injury
TEVAR is Superior to Open Repair for Blunt Aortic Injury

Royce Calhoun, MD, Stephanie Mayberg, PA-C, Bill Pevec, MD, Danh Nguyen, PhD^, Lisa Mu^

J. Nilas Young, MD John Laird, MDo

Division of Cardiothoracic Surgery

oDivision of Cardiology

^Department of Biostatistics

University of California Davis Medical Center

blunt aortic injury
Blunt Aortic Injury
  • 75% patients die at scene of accident
  • 5% are unstable and die shortly after accident
  • 25% of remainder die of other injuries
  • Traditional approach to repair has been emergent open repair
    • Paraplegia 2-19%, Mortality 15-35%
  • Current trend is appropriately timed urgent repair with an evolving endovascular role
    • Paraplegia 0%, Mortality 0-17%
methods
Methods
  • Comparison of open repair vs. stent for TTAT
  • 1999 to 2011
  • First thoracic aortic stent was October 2005
  • Exclusively stent repair for last 4 years
approach
Open

n=35

Thoracotomy, L groin 30

Partial bypass 24

Full bypass 7

DHCA 4

Thoracotomy, Gott shunt 1

Endograft

n=40

Femoral (cut down) 33

Iliac (RP with graft) 2

Infrarenal Aorta (4 RP, 1 Lap) 5

Approach
stent graft results
Stent Graft Results
  • Stents Used
    • 7 TAG
    • 1 C-TAG
    • 17 Excluder Cuffs
    • 4 AneuRx Cuffs
    • 2 Talent
    • 9 TX2
  • 36/40 immediate technical success
  • 39/40technical success after re-interventions
  • Complete coverage of traumatic tear with no stent migration or endoleaks at most recent follow-up
slide6
Case
  • 17 YO male, ejected from car
  • Intracranial bleed, multiple orthopedic injuries, splenic and liver lacerations
  • Bilateral severe pulmonary contusions
  • pO2 55 on 100% FIO2 with 20 PEEP
  • Comminuted aortic tear
conclusions
Conclusions
  • Endovascular stents for BAI can be performed safely with excellent short and mid-term results
  • Time from admission to intervention of BAI is increased in the stent group with no increased mortality
  • Stents for BAI are associated with decreased OR times and intraoperative blood transfusions compared to open