Endovascular versus open surgical repair for blunt thoracic aortic injury

a Lancashire Cardiac Centre, Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR, UK b Department of Vascular Surgery, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, UK *Corresponding author. Tel.: +1253 396495; Fax: +1253 657788. E-mail address : jamesbbarnard{at}doctors.org.uk (J. Barnard). A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether patients with acute traumatic thoracic aortic injury have a better outcome with endovascular or open surgical repair. Altogether, 283 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We concluded that the peri-procedural mortality rate for patients with traumatic thoracic blunt aortic injury is lower for patients treated with an endovascular stent graft when compared to the open technique. This important benefit is at the cost of a high procedure complication rate, requirement for long-term surveillance of the stent and uncertain medium and longer-term outcome. Key Words: Evidence-based medicine; Vascular surgery; Blunt thoracic aortic injury; Endovascular repair; Open repair