Thoracic endovascular aortic repair (TEVAR) is the standard-of-care for treating traumatic aortic injury (TAI). Few retrospective studies compared TEVAR to open repair in blunt traumatic aortic injury (BTAI). Our objectives were to compare the early outcomes of TEVAR for blunt traumatic descending aortic injury to open repair (OR) in polytraumatic patients involved in motor vehicle accidents (MVA). Between February 2005 and April 2017, 71 patients with TAI due to MVA presented to our institution. All patients with descending aortic injuries were considered for open repair (n = 41) or TEVAR (n = 30) if there was no contraindication. The primary outcome was mortality, and secondary outcomes were stroke, paraplegia, intensive care unit (ICU), and hospital stay. The mean age was 28.4 ± 10.1 years in the OR group and 33.3 ± 16.6 years in TEVAR-group (P = 0.13). The injury severity scores were 41 ± 10 in the OR group and 33 ± 17 in the TEVAR group (P = 0.03). Patients in the OR group underwent emergency repair with a mean time of 0.56 ± 0.18 days from arrival. The TEVAR group had a longer time interval between arrival and procedure (2.1 ± 1.7 days, P = 0.001). The OR group had more blood transfusion (24 (58.5%) vs. 8 (27.5%), P = 0.002), renal impairment (6 (14.6%) vs. 1 (5.50%), P = 0.23), and wound infection (21 (51.2%) vs. 3 (10%), P < 0.001). Three TEVAR patients had a perioperative stroke compared to two patients in the OR group (P = 0.64). There was no difference in the mean ICU (6 ± 8.9 vs. 5.3 ± 2.9 days; P = 0.1) or hospital stay (20.1 ± 12.3 vs. 20.1 ± 18.3, P = 0.62) between the two groups. There were four deaths in the OR group and none in the TEVAR group (P = 0.13). The results of TEVAR were comparable with the open repair for traumatic aortic injury with good early postoperative outcomes. TEVAR repair could be associated with lower mortality, blood transfusion, and infective complications. However, the complexity of the injury and technical challenges were higher in the open group.

中文翻译：

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TEVAR与开放性修复创伤多发性机动车辆事故患者的钝性降主动脉损伤

胸腔内血管主动脉修复术（TEVAR）是治疗外伤性主动脉损伤（TAI）的护理标准。很少有回顾性研究将TEVAR与钝性创伤性主动脉损伤（BTAI）的开放性修复相比较。我们的目的是比较TEVAR导致多发创伤的机动车辆事故（MVA）的钝性外伤性降主动脉开放修复（OR）的早期结果。在2005年2月至2017年4月之间，我院共收治了71例MVA致TAI患者。如果没有禁忌症，则考虑对所有主动脉下降损伤的患者进行开放性修补（n = 41）或TEVAR（n = 30）。主要结果为死亡率，次要结果为中风，截瘫，重症监护病房（ICU）和住院时间。OR组的平均年龄为28.4±10.1岁，OR组的平均年龄为33.3±16岁。TEVAR组治疗6年（P = 0.13）。OR组的损伤严重程度评分为41±10，TEVAR组的损伤严重程度评分为33±17（P = 0.03）。OR组的患者进行紧急修复，平均到达时间为0.56±0.18天。TEVAR组在到达和手术之间的时间间隔较长（2.1±1.7天，P = 0.001）。OR组输血更多（24（58.5％）比8（27.5％），P = 0.002），肾功能不全（6（14.6％）vs. 1（5.50％），P = 0.23）和伤口感染（21（51.2％）对3（10％），P <0.001）。与OR组中的两名患者相比，三名TEVAR患者发生了围手术期中风（P = 0.64）。两组的平均ICU（6±8.9 vs. 5.3±2.9天； P = 0.1）或住院时间（20.1±12.3 vs. 20.1±18.3，P = 0.62）没有差异。OR组有4例死亡，而TEVAR组无1例（P = 0.13）。TEVAR的结果与开放性修复创伤性主动脉损伤相当，术后早期效果良好。TEVAR修复可降低死亡率，输血和感染并发症。但是，公开组受伤的复杂性和技术挑战更高。