In a Patient with Blunt Traumatic Aortic Injury, Does TEVAR Improve Survival Compared to Open Repair or Expectant Management?

Abstract

Aortic injury remains a top cause of mortality in patients involved in traumatic mechanisms, especially following blunt trauma, where it is the second-most common cause of death. A significant number of these deaths occur prior to arriving at medical facilities. In addition, of those who reach a hospital, the diagnosis and treatment of aortic injury can pose significant clinical dilemmas. Blunt traumatic aortic injury (BTAI) is frequently associated with other injuries that may or may not pose a more urgent need for intervention. Improved diagnosis, based on high-fidelity computed tomography (CT) imaging, aggressive medical therapy with blood pressure control, minimally invasive treatment options using advanced devices, and streamlined treatment algorithms have improved the care of patients with BTAI. These significant developments have transitioned the treatment of patients with BTAI into a predominantly endovascular approach when repair is required. Surgeons have a much better evidence-based approach as to whether observation, open repair (OR), or an endovascular approach is the most appropriate form of treatment for a patient with BTAI. Even with these advancements, however, level I data remain sparse in the literature and single-center series still make up the predominant form of support for intervention options. This chapter examines the available evidence and shows that in patients with BTAI, TEVAR improves survival compared to OR or expectant management.