Emergency endovascular stent graft repair for acute blunt thoracic aortic injury: a retrospective case control study

Objective: To compare surgical and endovascular stent graft (ESG) treatment of blunt thoracic aortic injury (BAI) in the emergency setting. Design and setting: Retrospective case control study in two surgical intensive care units of a university hospital. Patients: 30 patients who presented with BAI between 1995 and 2005: 17 treated surgically and 13 by ESG. The two groups were comparable for the severity of trauma and mean delay before treatment; the mean age was higher in the ESG group (46 +/- 18 vs. 35 +/- 15 years). Results: In the surgical group time spent in the operating theater was longer (310 +/- 130 vs. 140 +/- 48 min) and blood losses higher (2000 +/- 1300 vs. no significant bleeding); aortic clamping time was 48 +/- 20 min. The mortality rate was 15% with ESG (n = 2) and 23% with surgery (n = 4). Complications of the procedure were more frequent in the surgical group (1 vs. 7). In the ESG group there was one pulmonary embolism. In the surgical group there were three neurological complications, one acute aortic dissection, one perioperative rupture, one periprosthetic leak, and one septic shock. Two complications (postoperative aortic dissection and paraplegia) appeared in the same patient in the surgical group. Intensive care unit length of stay, duration of mechanical ventilation, and catecholamine support were similar in the two groups. Conclusions: Stent graft for emergency treatment of BAI is efficient and is associated with fewer complications than surgical treatment.