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Citation
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Arbabi CN, Dubose J, Starnes BW, Saqib N, Quiroga E, Miller C, Azizzadeh A. J. Vasc. Surg. 2021; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION: Traumatic brain injury (TBI) and blunt thoracic aortic injury (BTAI) are the top two leading causes of death after blunt force trauma. Patients presenting with concomitant BTAI and TBI pose a specific challenge with respect to management strategy, as optimal hemodynamic parameters are conflicting between the two pathologies. Early TEVAR is often performed, even in minimal aortic injuries, to allow for the higher blood pressure parameters required in TBI management. However, the optimal timing of TEVAR for the treatment of BTAI in patients with concomitant TBI remains an active matter of controversy.
METHODS: The Aortic Trauma Foundation (ATF) international prospective multicenter registry was utilized to identify all patients who underwent TEVAR for BTAI in the setting of TBI from 2015 to 2020. Primary outcomes included delayed ischemic or hemorrhagic stroke, in-hospital mortality and aortic-related mortality. Outcomes were examined among patients who underwent TEVAR at emergent (< 6 vs. ≥ 6 hours) and urgent (< 24 vs. ≥ 24 hours) intervals.
RESULTS: A total of 100 patients (median age 43, 79% male, median ISS 41) with BTAI (SVS BTAI grade 1, 3%; grade 2, 10%; grade 3, 78%; grade 4, 9%) and concomitant TBI who underwent TEVAR were identified. Emergent repair was performed for 51 patients (51%). Comparing emergent repair (< 6 hrs) to repairs conducted at ≥ 6 hrs, there was no difference in delayed cerebral ischemic events (2.0% vs. 4.1%, p = 0.614), in-hospital mortality (15.7% vs. 22.4%, p = 0.389) or aortic-related mortality (2.0% vs. 2.0%, p = 0.996) and no patients had delayed hemorrhagic stroke. Likewise, repairs conducted in an urgent (< 24 hours) fashion had no difference compared to those completed ≥ 24 hours, with regards to delayed ischemic stroke (2.6% vs. 4.3%, p = 0.548), in-hospital mortality (18.2% vs. 21.7%, p = 0.764) or aortic-related mortality (1.3% vs. 4.3%, p = 0.654), with no patients having delayed hemorrhagic stroke.
CONCLUSIONS: In contrast to prior retrospective efforts, Results from the ATF international prospective multicenter registry demonstrate that neither emergent or urgent TEVAR for patients with concomitant BTAI and TBI is associated with delayed stroke, in-hospital or aortic-related mortality. In these patients, the timing of TEVAR did not have an impact on outcomes. Therefore, the decision to intervene should be guided by individual patient factors rather than timing.
Language: en |