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Home > Vascular Annual Meeting > PVSS4. Thoracic Aortic Trauma: Outcomes and Resource...

PVSS4. Thoracic Aortic Trauma: Outcomes and Resource Utilization for Endovascular vs. Open Repair

Albeir Y. Mousa, MD; Viktor Y. Dombrovskiy, MD, PhD,MPH; Brian W. Coyle, MD; Paul B. Haser, MD; Alan M. Graham, MD; Todd R. Vogel, MD, MPH
UMDNJ, New Brunswick, NJ

OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) has evolved as a treatment option for the management of thoracic aortic trauma. We evaluated outcomes and hospital utilization for TEVAR and Open Thoracic Aortic Repair (OTAR) when utilized in aortic trauma.

METHODS: Secondary analysis of the 2005-2006 Nationwide Inpatient Sample data.

RESULTS: 1,561 patients with thoracic aorta injury (mean age 44.8±18.8 years, men 77.2%) were identified. 480 underwent emergent surgical intervention: 245 OTAR (51%) and 235 TEVAR (49%). Males were 1.3 times (95%CI=1.03-1.75) as likely as females to undergo surgery and 1.8 times (95%CI=1.12-2.84) as likely to have TEVAR. Mortality after OTAR was greater compared to TEVAR (14.32% vs.8.52%; p=0.046). OTAR were 2.2 times as likely (95%CI=1.46-3.23) to have pulmonary complications compared to TEVAR. After adjustment by age, gender, and comorbidities mortality after OTAR was greater (OR=2.9; 95%CI=1.42-5.75) than after TEVAR. Advanced age, stroke and cardiac complications were significantly associated with increased mortality. LOS after OTAR and TEVAR was 23.8±19.25 and 13.5±13.51 days, respectively (p=0.0029). OTAR ($83,027±58,711) was significantly more expensive than after TEVAR ($57,092±48,191; p=0.0214). A significant increase in the proportion of patients with thoracic aorta injury undergoing repair was noted between 2005 and 2006 (24% vs.40.9%, p<0.0002).

CONCLUSIONS: The implementation of TEVAR was associated with a significant increase in the number of patients receiving intervention for traumatic aortic injury and decreased mortality. TEVAR was more likely performed on males and was associated with decreased pulmonary complications and hospital resource utilization. Further implementation of TEVAR for aortic trauma may improve future outcomes and reduce hospital utilization.

AUTHOR DISCLOSURES: A.Y. Mousa, None; V.Y. Dombrovskiy, None; B.W. Coyle, None: P.B. Haser, None; A.M. Graham, None; T.R. Vogel, None.