• Annals of surgery · Jul 2022

    Management and In-hospital Mortality of 2235 Patients With a Traumatic Intimal Tear of the Thoracic Aorta.

    • Jean Jacob-Brassard, Mohammed Al-Omran, Avery B Nathens, Thomas L Forbes, and Charles de Mestral.
    • Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
    • Ann. Surg. 2022 Jul 1; 276 (1): 186-192.

    ObjectiveOur goal was to describe contemporary management and inhospital mortality associated with blunt thoracic aortic intimal tears (IT) within the American College of Surgeons Trauma Quality Improvement Program.Summary Background DataThe evidence basis for nonoperative expectant management of traumatic iT of the thoracic aorta remains weak.MethodsAll adult patients with a thoracic aortic IT following blunt trauma were captured from Level I and II North American Centers enrolled in Trauma Quality Improvement Program from 2010 to 2017. For each patient, we extracted demographics, injury characteristics, the timing and approach of thoracic aortic repair and in-hospital mortality. Mortality attributable to IT was calculated by comparing IT patients to a propensity-score matched control cohort of severely injured blunt trauma patients without aortic injury.ResultsThere were 2203 IT patients across 315 facilities. Injury most often resulted from motor vehicle collision (75%). A total of 758 patients (34%) underwent operative management, with 93% (N = 708) of repairs performed via an endovascular approach. Median time to surgery was 11 hours (IQR 4- 40). The frequency of operative management was higher in patients without traumatic brain injury (TBI) (35%, N = 674) compared to those with TBI (29%, N = 84) (P = 0.024). Compared to severely injured blunt trauma patients without aortic injury, ITwas not associated with additional in-hospital mortality (10.7% for IT vs 11.7% for no IT, absolute risk difference: -1.0%, 95% CI: -2.9% to 0.8%).ConclusionsThe majority of blunt thoracic IT are managed nonoperatively and IT does not confer additional in-hospital mortality risk. Future studies should focus on the risk of injury progression.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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