Traumatic Aortic Rupture: 30 Years of Experience

BackgroundTo evaluate outcome differences in open surgical and endovascular treatment of traumatic aortic rupture (TAR) over a period of 30 years.MethodsWe retrospectively reviewed the diagnostic workup and management of all patients and compared outcome before and since the era of endovascular therapy.ResultsBetween 1980 and 2010, 72 patients with a mean age of 38 years (range, 14-76) were treated for TAR. Of these, 48 (67%) were treated by open surgery and the remaining 24 (33%) by thoracic endovascular aortic repair (TEVAR). In the open surgery group, mortality was 16.7% and paraplegia occurred in 8.3% of patients, whereas mortality was 4.2% and no paraplegia occurred in the TEVAR group. Diagnostic workup consisted of chest X-ray and arteriography in the early period, whereas computed tomographic scan and transesophageal echography were preferred in the more recent period.ConclusionsAlthough our results could not reach statistical significance, mainly because of the gross oversizing of the open group in comparison with the TEVAR group, TEVAR has introduced a less invasive era in the treatment of TAR and has become the therapy of choice. The diagnostic workup has evolved from chest X-ray and arteriography to computed tomographic scanning and even transesophageal echography.