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TEVAR is Superior to Open Repair for Blunt Aortic Injury

TEVAR is Superior to Open Repair for Blunt Aortic Injury. Royce Calhoun, MD, Stephanie Mayberg, PA-C, Bill Pevec, MD, Danh Nguyen, PhD^, Lisa Mu^ J. Nilas Young, MD John Laird, MD o Division of Cardiothoracic Surgery o Division of Cardiology ^Department of Biostatistics

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TEVAR is Superior to Open Repair for Blunt Aortic Injury

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  1. TEVAR is Superior to Open Repair for Blunt Aortic Injury Royce Calhoun, MD, Stephanie Mayberg, PA-C, Bill Pevec, MD, Danh Nguyen, PhD^, Lisa Mu^ J. Nilas Young, MD John Laird, MDo Division of Cardiothoracic Surgery oDivision of Cardiology ^Department of Biostatistics University of California Davis Medical Center

  2. Blunt Aortic Injury • 75% patients die at scene of accident • 5% are unstable and die shortly after accident • 25% of remainder die of other injuries • Traditional approach to repair has been emergent open repair • Paraplegia 2-19%, Mortality 15-35% • Current trend is appropriately timed urgent repair with an evolving endovascular role • Paraplegia 0%, Mortality 0-17%

  3. Methods • Comparison of open repair vs. stent for TTAT • 1999 to 2011 • First thoracic aortic stent was October 2005 • Exclusively stent repair for last 4 years

  4. Open n=35 Thoracotomy, L groin 30 Partial bypass 24 Full bypass 7 DHCA 4 Thoracotomy, Gott shunt 1 Endograft n=40 Femoral (cut down) 33 Iliac (RP with graft) 2 Infrarenal Aorta (4 RP, 1 Lap) 5 Approach

  5. Stent Graft Results • Stents Used • 7 TAG • 1 C-TAG • 17 Excluder Cuffs • 4 AneuRx Cuffs • 2 Talent • 9 TX2 • 36/40 immediate technical success • 39/40technical success after re-interventions • Complete coverage of traumatic tear with no stent migration or endoleaks at most recent follow-up

  6. Case • 17 YO male, ejected from car • Intracranial bleed, multiple orthopedic injuries, splenic and liver lacerations • Bilateral severe pulmonary contusions • pO2 55 on 100% FIO2 with 20 PEEP • Comminuted aortic tear

  7. Results

  8. Results

  9. Major Adverse Events

  10. Conclusions • Endovascular stents for BAI can be performed safely with excellent short and mid-term results • Time from admission to intervention of BAI is increased in the stent group with no increased mortality • Stents for BAI are associated with decreased OR times and intraoperative blood transfusions compared to open

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