Thoracic aortic stenting tops surgery for management of blunt trauma

Endovascular repair is better and safer than surgery for the treatment of blunt thoracic aortic trauma, according to the largest review of clinical data to date comparing both procedures. Stent-grafts could save more lives and reduce the risk of paraplegia, a frequent surgical complication.

Nearly one-quarter of all lethal traumatic injuries from falls or automotive collisions involve a torn or dissected thoracic aorta. And about two out of 10 patients who make it to the hospital with this type of injury die within a few hours due to internal bleeding. Surgical repair remains the standard of care, but surgery requires clamping the aorta, which raises the risk of insufficient blood supply to the spine, rendering a patient paraplegic.

All available data comparing surgery with endovascular repair indicate the latter should be the procedure of choice for treatment of the most common traumatic aortic injury, said principal investigator Dr. Eric K. Hoffer, director of vascular and interventional radiology at Dartmouth Medical School.

"This minimally invasive interventional radiology technique can decrease the death rate by half and diminish the risk of paraplegia by 75% as compared with open surgical repair," Hoffer said.

In their systematic metastudy, Hoffer and colleagues reviewed 19 studies comparing 262 endograft repairs versus 376 open surgeries. The investigators found that, compared with surgery and intensive care methods, endovascular stenting of the thoracic aorta had brought mortality rates down from about 60% to less than 30% on average. Stenting further reduced mortality by almost 10% in some cases, likely as a result of decreased systemic stress afforded by endovascular repair.

They published their findings in the August issue of the Journal of Vascular and Interventional Radiology.

The researchers found no prospective randomized studies. The odds ratio for mortality after endovascular versus open repair was 0.43 (p = 0.001). The odds ratio for paraplegia after endovascular versus open repair was 0.30 (p = 0.01). In the pooled group of endovascular repair survivors, the incidence of early and late endoleak was 4.2%, and 0.9%, respectively. The rate of stroke or transient ischemic attack was 1.2%. Slightly over 4% of cases led to complications requiring further intervention.

"This study provides another indication of the tremendous innovation in the development of new devices and techniques that interventional radiology continues to offer," Hoffer said.

For more information from the Diagnostic Imaging archives:

Thoracic aortic stenting outperforms surgery

Long-term data validate thoracic aortic stenting

Thoracic aortic stenting shows good short-term results

Interventional techniques become cornerstones of traumatic injury management