National Trends of Thoracic Endovascular Aortic Repair Versus Open Repair in Blunt Thoracic Aortic Injury
Blunt thoracic aortic injury (BTAI) occurs in
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| Veröffentlicht in: | Annals of vascular surgery 2018-10, Vol.52, p.72-78 |
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| container_title | Annals of vascular surgery |
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| creator | Grigorian, Areg Spencer, Dean Donayre, Carlos Nahmias, Jeffry Schubl, Sebastian Gabriel, Viktor Barrios, Cristobal |
| description | Blunt thoracic aortic injury (BTAI) occurs in |
| doi_str_mv | 10.1016/j.avsg.2018.03.045 |
| format | Article |
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This was a retrospective analysis of the National Trauma Data Bank from 2007 to 2015. The primary end points of interest included the incidence of TEVAR and open repair, as well as mortality in BTAI patients undergoing intervention. Covariates were included in a multivariable analysis to determine risk for mortality in BTAI patients undergoing open repair versus TEVAR.
We identified 3,628 BTAI patients undergoing intervention. Of these, 3,226 underwent TEVAR (87.9%), and 445 (12.1%) underwent open repair. Compared with open repair, TEVAR had a shorter mean length of stay (LOS) (19.8 vs. 21.3 days, P < 0.05) and lower rates of acute kidney injury (AKI) (5.6% vs. 9.0%, P < 0.05) and mortality (8.8% vs. 12.8%, P < 0.05). Open repair had greater risk for mortality than TEVAR (odds ratio = 1.63, confidence intervals = 1.19–2.23, P < 0.05).
The rate of open repair decreased from 7.4% in 2007 to 1.9% in 2015, whereas TEVAR increased from 12.1 to 25.7% during the same time period. We confirmed previous findings that endovascular repair is associated with decreased mortality, LOS, and major complications, including AKI. Future investigations should focus on identifying the ideal patient candidate for TEVAR and elucidate precise indications for TEVAR in BTAI.</description><identifier>ISSN: 0890-5096</identifier><identifier>EISSN: 1615-5947</identifier><identifier>DOI: 10.1016/j.avsg.2018.03.045</identifier><identifier>PMID: 29886219</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Adult ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - surgery ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - mortality ; Blood Vessel Prosthesis Implantation - trends ; Databases, Factual ; Endovascular Procedures - adverse effects ; Endovascular Procedures - mortality ; Endovascular Procedures - trends ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; North America - epidemiology ; Postoperative Complications - epidemiology ; Retrospective Studies ; Risk Factors ; Thoracic Injuries - diagnostic imaging ; Thoracic Injuries - mortality ; Thoracic Injuries - surgery ; Time Factors ; Treatment Outcome ; Vascular System Injuries - diagnostic imaging ; Vascular System Injuries - mortality ; Vascular System Injuries - surgery ; Wounds, Nonpenetrating - diagnostic imaging ; Wounds, Nonpenetrating - mortality ; Wounds, Nonpenetrating - surgery ; Young Adult</subject><ispartof>Annals of vascular surgery, 2018-10, Vol.52, p.72-78</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-62ac9141ddc8018ba1fa4f3581f4e8e3426370e7692f903a6dacc374a0320bdd3</citedby><cites>FETCH-LOGICAL-c422t-62ac9141ddc8018ba1fa4f3581f4e8e3426370e7692f903a6dacc374a0320bdd3</cites><orcidid>0000-0002-0998-796X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S089050961830431X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29886219$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grigorian, Areg</creatorcontrib><creatorcontrib>Spencer, Dean</creatorcontrib><creatorcontrib>Donayre, Carlos</creatorcontrib><creatorcontrib>Nahmias, Jeffry</creatorcontrib><creatorcontrib>Schubl, Sebastian</creatorcontrib><creatorcontrib>Gabriel, Viktor</creatorcontrib><creatorcontrib>Barrios, Cristobal</creatorcontrib><title>National Trends of Thoracic Endovascular Aortic Repair Versus Open Repair in Blunt Thoracic Aortic Injury</title><title>Annals of vascular surgery</title><addtitle>Ann Vasc Surg</addtitle><description>Blunt thoracic aortic injury (BTAI) occurs in <1% of all trauma admissions. Considering the advent of multiple thoracic endovascular aortic repair (TEVAR) devices over the past decade, improved outcomes of TEVAR supported in the literature, rapid diagnosis, and improved preoperative planning of BTAI using computed tomography imaging, we hypothesized that the national incidence of TEVAR in BTAI has increased while open repair has decreased. In addition, we hypothesized that the mortality risk in BTAI patients undergoing TEVAR would be lower than open repair.
This was a retrospective analysis of the National Trauma Data Bank from 2007 to 2015. The primary end points of interest included the incidence of TEVAR and open repair, as well as mortality in BTAI patients undergoing intervention. Covariates were included in a multivariable analysis to determine risk for mortality in BTAI patients undergoing open repair versus TEVAR.
We identified 3,628 BTAI patients undergoing intervention. Of these, 3,226 underwent TEVAR (87.9%), and 445 (12.1%) underwent open repair. Compared with open repair, TEVAR had a shorter mean length of stay (LOS) (19.8 vs. 21.3 days, P < 0.05) and lower rates of acute kidney injury (AKI) (5.6% vs. 9.0%, P < 0.05) and mortality (8.8% vs. 12.8%, P < 0.05). Open repair had greater risk for mortality than TEVAR (odds ratio = 1.63, confidence intervals = 1.19–2.23, P < 0.05).
The rate of open repair decreased from 7.4% in 2007 to 1.9% in 2015, whereas TEVAR increased from 12.1 to 25.7% during the same time period. We confirmed previous findings that endovascular repair is associated with decreased mortality, LOS, and major complications, including AKI. Future investigations should focus on identifying the ideal patient candidate for TEVAR and elucidate precise indications for TEVAR in BTAI.</description><subject>Adult</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aorta, Thoracic - surgery</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Blood Vessel Prosthesis Implantation - trends</subject><subject>Databases, Factual</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - mortality</subject><subject>Endovascular Procedures - trends</subject><subject>Female</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Middle Aged</subject><subject>North America - epidemiology</subject><subject>Postoperative Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Thoracic Injuries - diagnostic imaging</subject><subject>Thoracic Injuries - mortality</subject><subject>Thoracic Injuries - surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular System Injuries - diagnostic imaging</subject><subject>Vascular System Injuries - mortality</subject><subject>Vascular System Injuries - surgery</subject><subject>Wounds, Nonpenetrating - diagnostic imaging</subject><subject>Wounds, Nonpenetrating - mortality</subject><subject>Wounds, Nonpenetrating - surgery</subject><subject>Young Adult</subject><issn>0890-5096</issn><issn>1615-5947</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1r20AURYeSUrtp_0AXQctspLz5kDSCbFyTNAHTQHG7HcYzT80IecadkQz595WxneyyenC558I7hHyjUFCg1U1X6H36WzCgsgBegCg_kDmtaJmXjagvyBxkA3kJTTUjn1PqACiTQn4iM9ZIWTHazIn7qQcXvO6zdURvUxbabP0cojbOZHfehr1OZux1zBYhDlP2C3faxewPxjSm7GmH_hw5n33vRz-88Sfk0XdjfPlCPra6T_j1dC_J7_u79fIhXz39eFwuVrkRjA15xbRpqKDWGjk9ttG01aLlpaStQIlcsIrXgHXVsLYBriurjeG10MAZbKzll-T6uLuL4d-IaVBblwz2vfYYxqQYlJzVtKxhqrJj1cSQUsRW7aLb6viiKKiDYtWpg2J1UKyAq0nxBF2d9sfNFu0rcnY6FW6PBZy-3DuMKhmH3qB1Ec2gbHDv7f8HW-yNbQ</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Grigorian, Areg</creator><creator>Spencer, Dean</creator><creator>Donayre, Carlos</creator><creator>Nahmias, Jeffry</creator><creator>Schubl, Sebastian</creator><creator>Gabriel, Viktor</creator><creator>Barrios, Cristobal</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0998-796X</orcidid></search><sort><creationdate>201810</creationdate><title>National Trends of Thoracic Endovascular Aortic Repair Versus Open Repair in Blunt Thoracic Aortic Injury</title><author>Grigorian, Areg ; Spencer, Dean ; Donayre, Carlos ; Nahmias, Jeffry ; Schubl, Sebastian ; Gabriel, Viktor ; Barrios, Cristobal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-62ac9141ddc8018ba1fa4f3581f4e8e3426370e7692f903a6dacc374a0320bdd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - surgery</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Blood Vessel Prosthesis Implantation - trends</topic><topic>Databases, Factual</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - mortality</topic><topic>Endovascular Procedures - trends</topic><topic>Female</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Middle Aged</topic><topic>North America - epidemiology</topic><topic>Postoperative Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Thoracic Injuries - diagnostic imaging</topic><topic>Thoracic Injuries - mortality</topic><topic>Thoracic Injuries - surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular System Injuries - diagnostic imaging</topic><topic>Vascular System Injuries - mortality</topic><topic>Vascular System Injuries - surgery</topic><topic>Wounds, Nonpenetrating - diagnostic imaging</topic><topic>Wounds, Nonpenetrating - mortality</topic><topic>Wounds, Nonpenetrating - surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grigorian, Areg</creatorcontrib><creatorcontrib>Spencer, Dean</creatorcontrib><creatorcontrib>Donayre, Carlos</creatorcontrib><creatorcontrib>Nahmias, Jeffry</creatorcontrib><creatorcontrib>Schubl, Sebastian</creatorcontrib><creatorcontrib>Gabriel, Viktor</creatorcontrib><creatorcontrib>Barrios, Cristobal</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grigorian, Areg</au><au>Spencer, Dean</au><au>Donayre, Carlos</au><au>Nahmias, Jeffry</au><au>Schubl, Sebastian</au><au>Gabriel, Viktor</au><au>Barrios, Cristobal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>National Trends of Thoracic Endovascular Aortic Repair Versus Open Repair in Blunt Thoracic Aortic Injury</atitle><jtitle>Annals of vascular surgery</jtitle><addtitle>Ann Vasc Surg</addtitle><date>2018-10</date><risdate>2018</risdate><volume>52</volume><spage>72</spage><epage>78</epage><pages>72-78</pages><issn>0890-5096</issn><eissn>1615-5947</eissn><abstract>Blunt thoracic aortic injury (BTAI) occurs in <1% of all trauma admissions. Considering the advent of multiple thoracic endovascular aortic repair (TEVAR) devices over the past decade, improved outcomes of TEVAR supported in the literature, rapid diagnosis, and improved preoperative planning of BTAI using computed tomography imaging, we hypothesized that the national incidence of TEVAR in BTAI has increased while open repair has decreased. In addition, we hypothesized that the mortality risk in BTAI patients undergoing TEVAR would be lower than open repair.
This was a retrospective analysis of the National Trauma Data Bank from 2007 to 2015. The primary end points of interest included the incidence of TEVAR and open repair, as well as mortality in BTAI patients undergoing intervention. Covariates were included in a multivariable analysis to determine risk for mortality in BTAI patients undergoing open repair versus TEVAR.
We identified 3,628 BTAI patients undergoing intervention. Of these, 3,226 underwent TEVAR (87.9%), and 445 (12.1%) underwent open repair. Compared with open repair, TEVAR had a shorter mean length of stay (LOS) (19.8 vs. 21.3 days, P < 0.05) and lower rates of acute kidney injury (AKI) (5.6% vs. 9.0%, P < 0.05) and mortality (8.8% vs. 12.8%, P < 0.05). Open repair had greater risk for mortality than TEVAR (odds ratio = 1.63, confidence intervals = 1.19–2.23, P < 0.05).
The rate of open repair decreased from 7.4% in 2007 to 1.9% in 2015, whereas TEVAR increased from 12.1 to 25.7% during the same time period. We confirmed previous findings that endovascular repair is associated with decreased mortality, LOS, and major complications, including AKI. Future investigations should focus on identifying the ideal patient candidate for TEVAR and elucidate precise indications for TEVAR in BTAI.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>29886219</pmid><doi>10.1016/j.avsg.2018.03.045</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0998-796X</orcidid></addata></record> |
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| subjects | Adult Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - surgery Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - mortality Blood Vessel Prosthesis Implantation - trends Databases, Factual Endovascular Procedures - adverse effects Endovascular Procedures - mortality Endovascular Procedures - trends Female Humans Length of Stay Male Middle Aged North America - epidemiology Postoperative Complications - epidemiology Retrospective Studies Risk Factors Thoracic Injuries - diagnostic imaging Thoracic Injuries - mortality Thoracic Injuries - surgery Time Factors Treatment Outcome Vascular System Injuries - diagnostic imaging Vascular System Injuries - mortality Vascular System Injuries - surgery Wounds, Nonpenetrating - diagnostic imaging Wounds, Nonpenetrating - mortality Wounds, Nonpenetrating - surgery Young Adult |
| title | National Trends of Thoracic Endovascular Aortic Repair Versus Open Repair in Blunt Thoracic Aortic Injury |
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