Outcomes of Early versus Delayed Endovascular Repair of Blunt Traumatic Aortic Injuries
Journal Title: Oman Medical Journal - Year 2019, Vol 34, Issue 4
Abstract
Objectives: Thoracic endovascular aortic repair (TEVAR) has surpassed open surgical repair in the management of blunt traumatic aortic injuries (BTAIs) over the past two decades. It is a less morbid procedure associated with lower mortality. We sought to determine the outcomes of early versus delayed TEVAR of BTAI in our population. Methods: We conducted a retrospective analysis of a prospectively collected registry that looked at patients presenting with an image-proven diagnosis of BTAI at three tertiary health care facilities in Muscat, Oman. Forty consecutive patients were identified between January 2012 and July 2017, of which four were excluded for incomplete data. The remaining 36 patients were divided based on the timing of repair into early (< 7 days) or delayed (≥ 7 days) repair. In both cohorts, variables analyzed included patient demographics, mechanism of injury, injury severity score, need for blood products transfusion, use of anti-impulse medications, anticoagulation, intensive care unit (ICU) stay, and total hospital stay. Primary endpoints included: in-hospital mortality, TEVAR-related morbidity, and the need for reintervention. Results: Our study subjects were young with a mean age of 33.5±14.8 and 29.9±11.0 years in the early and delayed repair cohorts, respectively. Motor vehicle collisions accounted for the majority of cases (82.6% and 76.9% in early and delayed repair, respectively). Thoracic injuries were the most commonly associated injuries in both early and delayed repair cohorts. Compared to early repair, the delayed repair cohort had a higher incidence of exploratory laparotomies, but the difference was not statistically significant (p = 0.161). There were four incidences of cerebrovascular accidents (CVAs) post-TEVAR; three in the early repair cohort and one in the delayed repair cohort (p = 1.000). There was no statistically significant correlation between left subclavian total or partial coverage and the incidence of CVA (p = 0.220) and type 1 (p = 0.466) or type 2 endoleak (p = 0.102). The early repair cohort had a longer but not statistically significant ICU stay (7.8±6.8 vs. 5.3±10.7, p = 0.386). Prolonged ICU stay was associated with more blood transfusion requirement (p < 0.001), and higher respiratory (p = 0.010) and gastrointestinal complications (p = 0.026). Conclusions: The short-term outcomes for TEVAR of BTAI continue to show its feasibility in managing BTAI in severely injured patients. There was no clear statistical significance in mortality and morbidity comparing early versus delayed repair. However, our experience is based on a small sample size and short median follow-up but provides a good platform for further analysis.
Authors and Affiliations
Sulaiman Al Shamsi, Ahmed Naiem, Ibrahim Abdelhadi, Khalid Al Manei, Sachin Jose, Rashid Al Sukaiti, Khalifa Al Wahaibi
Keywords
Related Articles
- EP ID EP608399
- DOI 10.5001/omj.2019.57
- Views 73
- Downloads 0
Major Determinants of Maternal Near-Miss and Mortality at the Maternity Teaching Hospital, Erbil city, Iraq
Objectives: To find out the major determinants of maternal near-miss (NM)and maternal deaths (MDs) in Erbil city, Iraq, by comparative analysis of maternal NMs and MDs. Methods: We conducted a hospital-based cross-sectio...
The Forgotten Role of Bystander CPR to Improve Out of Hospital Cardiac Arrest Outcomes in Oman
The collapse of a young healthy adult in the workplace or on a football field, or the collapse of a senior family member at home are not uncommon events in the Omani community. Out of hospital cardiac arrest remains the...
Genetic Diversity Analysis of Methicillin-resistant Staphylococcus aureus Strains Isolated from Intensive Care Unit in Iran
Objectives: Staphylococcus aureus has emerged as a major public health concern. It is a common pathogen in high-risk hospital intensive care units (ICUs). We analyzed the molecular characteristics on the SCCmec and spa g...
Interprofessional Competency Framework for Health Service Managers in Oman: An e-Delphi Study
Objectives: This study aimed to develop the required interprofessional competencies for health service managers in Oman. Methods: Experts (n = 20) were selected based on their years’ experience, position, fluency in Engl...
The Association of a Rare Variant of -93, -53 Promoter Gene Polymorphisms of Lipoprotein Lipase Gene with Obesity and Insulin Resistance
Objectives: Obesity increases the risk of numerous chronic diseases. Obesity is classified clinically using body mass index (BMI), waist-to-hip ratio, and body fat percentage. The lipoprotein lipase (LPL) gene has been l...