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Stent versus open surgery for acute and chronic traumatic injury of the thoracic aorta: a single-center experience.

BACKGROUND
Traumatic injuries of the thoracic aorta have a high morbidity and mortality. Treatment options include either open surgery or endovascular stent graft implantation.


METHODS
We have reviewed retrospectively all our patients treated for acute and chronic traumatic injury of the thoracic aorta and compared the outcome of the endovascular versus open therapy. Age, gender, severity of injuries, interventional delay, perioperative morbidity, 30-day mortality, length of intensive care, and overall hospital stay were evaluated.


RESULTS
In all, 46 patients were treated over the past 14 years. Overall 30-day mortality was 16% in patients treated for acute or contained aortic ruptures (n = 31) and not significantly different after endovascular versus open repair (13.3% versus 18.8%). There was no mortality in the patients receiving elective stent grafting or open surgery for chronic posttraumatic aortic aneurysms (n = 15). Conversion and/or operative revision following stent graft implantation occurred in three patients (12.5%). Neurologic complications were absent in the stent graft group (0 of 24), whereas paraplegia (n = 2) or minor neurologic (n = 3) deficits developed following open surgery (5 of 22; 22.7%; p = 0.013). Length of intensive care and overall hospital stay were significantly shorter for patients after elective stent graft treatment compared with open surgery (p = 0.045).


CONCLUSIONS
According to our midterm results, minimally invasive endovascular repair for patients with acute traumatic ruptures and chronic posttraumatic aneurysms is an equally effective treatment option compared with open surgery, with advantages regarding perioperative neurologic complications and duration of hospital stay under elective circumstances.