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Outcomes of Early versus Delayed Endovascular Repair of Blunt Traumatic Aortic Injuries.
Al Shamsi, Sulaiman; Naiem, Ahmed; Abdelhadi, Ibrahim; Al Manei, Khalid; Jose, Sachin; Al Sukaiti, Rashid; Al Hajeri, Mahmood; Al Wahaibi, Khalifa.
Afiliación
  • Al Shamsi S; Vascular Surgery Unit, Department of Surgery, Royal Hospital, Muscat, Oman.
  • Naiem A; General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman.
  • Abdelhadi I; Division of Vascular Surgery, McGill University, Quebec, Canada.
  • Al Manei K; Vascular Surgery Unit, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.
  • Jose S; Radiology Residency Program, Oman Medical Specialty Board, Muscat, Oman.
  • Al Sukaiti R; Research Section, Planning and Studies Department, Oman Medical Specialty Board, Muscat, Oman.
  • Al Hajeri M; Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman.
  • Al Wahaibi K; Department of Radiology, Royal Hospital, Muscat, Oman.
Oman Med J ; 34(4): 283-289, 2019 Jul.
Article en En | MEDLINE | ID: mdl-31360315
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 (3 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Prognostic_studies Idioma: En Revista: Oman Med J Año: 2019 Tipo del documento: Article País de afiliación: Omán Pais de publicación: Omán

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Prognostic_studies Idioma: En Revista: Oman Med J Año: 2019 Tipo del documento: Article País de afiliación: Omán Pais de publicación: Omán