Stent Grafts Treat Blunt Trauma Injuries Better

A new study has found that endovascular repair is a better option for treating lethal injuries from high-speed collisions or falls, saving more lives and nearly eliminating paraplegia, a complication of surgical repair for thoracic aortic aneurysms.

Researchers at Dartmouth Medical School (DMS, Hanover, NH, USA) conducted a systematic review of 50 reports involving 722 cases of endovascular repair of acute traumatic aortic injury since 1990. Meta-analysis of publications with open and stent-graft repair cohorts was performed to evaluate whether there was a difference in treatment effect with regard to mortality and paraplegia. Case series were included to obtain an adequate population to assess the incidence of stent-graft procedure-related complications. In all, 19 publications that compared the outcomes of 262 endograft repairs and 376 open surgical repairs were identified.

The study found that the "endovascular advantage” reduced mortality to 8–9%, compared to 18–28% in contemporary intensive care and surgical methods. In the pooled group of 667 endovascular repair survivors from 50 reports, the incidence of early endoleak was 4.2%, and late endoleak occurred in 0.9%. Stroke or transient ischemic attack (TIA) was reported in 1.2%. Access site complications that required intervention occurred in 4.1%. The odds ratio for mortality after endovascular versus open repair was 0.43, and the odds ratio for paraplegia after endovascular versus open repair was 0.30. The researchers explain that the improved survival rate may be a result of the decreased systemic stress that endovascular repair affords, an important factor for patients where additional severe injuries are common. The study was published in the August 2008, issue of the Journal of Vascular and Interventional Radiology (JVIR).

"Analysis of the available data provides unequivocal support for endovascular repair to replace open surgery as the procedure of choice for repair of the most common traumatic aortic injury,” said lead author Eric Hoffer, M.D., director of vascular and interventional radiology at Dartmouth. "This minimally invasive interventional radiology technique can decrease the death rate by half and diminish the risk of paraplegia by 75% as compared to open surgical repair.”

Injuries causing thoracic (chest) aortic trauma account for as much as 25% of all motor vehicle trauma-related deaths, and most of these individuals die at the scene of the injury. Those that survive the crash may die within hours of hospitalization, often due to partial tears of the artery wall not obvious initially. If left untreated, the artery could expand and eventually rupture, resulting in massive bleeding into the chest, which is invariably fatal. During surgery, a patient is at increased risk of paraplegia because the thoracic aorta is clamped, cutting off blood to the spinal column; in endovascular surgery, however, the treatment does not interrupt the blood supply. The treatment provides a less invasive option with less pain, less recovery time, and a lower risk of complications than open surgery.

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