Introduction
Methods
Setting
Patient selection
Patient characteristics
Diagnostics
Outcomes and follow-up
Institutional management strategy
Statistical analysis
Results
Patient demographics and institutional management
All BTAI patients (n = 31) | TEVAR patients (n = 19) | |
---|---|---|
Age (years) | 33 [23–48] | 35 [25–46] |
Male | 24 (77) | 16 (84) |
ISS | 38 [29–54] | 34 [29–50] |
Polytrauma | 31 (100) | 19 (100) |
Mechanism of injury | ||
MVC | 25 (81) | 17 (90) |
Fall from height (> 2 m) | 3 (10) | 1 (5) |
Pedestrian collision | 1 (3) | 0 (0) |
Blast injury | 1 (3) | 0 (0) |
Train collision | 1 (3) | 1 (5) |
Systolic blood pressure | 100 [80–120] | 110 [80–120] |
≤ 90 mmHg | 15 (48) | 6 (32) |
Pulse (bpm) | 100 [85–120] | 103 [85–120] |
Hemodynamic instability | 9 (29) | 2 (11) |
Cardiac arrest upon arrival at the ED | 5 (16) | 0 (0) |
Hb (mmol/L) | 7.8 [6.9–8.7] | 8.0 [7.0–8.9] |
Arterial pHa | 7.26 [7.09–7.32] | 7.26 [7.13–7.33] |
Lactate (mmol/L)a | 3.3 [2.5–5.6] | 3.2 [2.5–5.6] |
Base deficit (mEq/L)a | 7.0 [3.1–11.0] | 5.0 [3.0–10.0] |
BTAI injury gradeb | ||
Grade I | 1 (3) | 0 (0) |
Grade II | 2 (6) | 1 (5) |
Grade III | 22 (71) | 18 (95) |
Grade IV | 6 (19) | 0 (0) |
Treatment (aortic repair) | ||
Early TEVAR | 15 (48) | 15 (79) |
Delayed TEVAR | 4 (13) | 4 (21) |
Conservative | 2 (6) | N/a |
Died before repair | 10 (32) | N/a |
Additional treatmentc | ||
Craniotomy | 1 (3) | 1 (5) |
Thoracotomy | 4 (13) | 0 (0) |
Laparotomy | 7 (23) | 5 (26) |
Pelvic fracture surgery | 3 (10) | 1 (5) |
Spinal fracture surgery | 5 (16) | 3 (16) |
Extremity fracture surgery | 8 (26) | 6 (32) |
Hospital stay (days) | 10 [0–26] | 21 [8–41] |
ICU stay (days) | 2 [0–11] | 9 [1–13] |
Outcomes | ||
In-hospital mortality | 13 (42) | 3 (16) |
BTAI-related mortality | 5 (16) | 0 (0) |
Cause of in-hospital death | ||
Hemorrhage (aortic) | 4 (13) | 0 (0) |
Multi-organ failure | 3 (10) | 1 (5) |
Traumatic brain injury | 3 (10) | 2 (11) |
Myocardial contusion | 2 (6) | 0 (0) |
Futility | 1 (3) | 0 (0) |
TEVAR patients (n = 19) | |
---|---|
Associated injuriesa | |
Brain injury | 10 (53) |
Thoracic injury | 17 (90) |
Abdominal injury | 11 (58) |
Pelvic injury | 8 (42) |
Extremity fracture | 8 (42) |
Associated spine injuriesa | |
Cervical | 5 (26) |
Thoracic | 5 (26) |
Lumbar | 5 (26) |
Spinal cord injury | 3 (16) |
TEVAR procedure details | |
TEVAR procedure time (minutes) | 95 [80–132] |
Median (IQR) TEVAR diameter (mm) | 26 [24–30] |
Median (IQR) TEVAR length (mm) | 150 [100–151] |
Median (IQR) procedural MAP (mmHg) | 68 [62–79] |
Simultaneous surgery patientsb | 6 (32) |
Laparotomy | 3 (16) |
Extremity surgery | 2 (11) |
Craniotomy | 1 (5) |
Spine fracture surgery | 1 (5) |
Additional procedure time (minutes) | 75 [20–153] |
TEVAR procedure time (minutes) | 115 [80–125] |
Procedure details
Early outcomes
Early outcomes | (n = %) | Long-term outcomes | (n = %) |
---|---|---|---|
Implantation success | 19 (100) | BTAI-related out-of-hospital mortality | 0 (0) |
Complete left subclavian artery coverage | 12 (63) | Patients lost to follow-upc | 3 (19) |
Median (IQR) delay (days)a | 0.4 (0.25–0.50) | Median (IQR) radiographic follow-up (years) | 3.0 (2.1–5.5) |
Cerebral ischemia | 4 (21) | Endoleaks | 0 (0) |
Access route injury | 1 (5) | Stent fracture | 0 (0) |
Conversion | 0 (0) | Occlusion and need for open repair | 1 (6) |
Left arm ischemia | 0 (0) | Left arm claudication | 0 (0) |
Spinal cord ischemiab | 1 (5) | ||
Endoleaks | 0 (0) | ||
In-hospital mortality | 3 (16) | ||
BTAI-related in-hospital mortality | 0 (0) |
Traumatic brain injury
Long-term outcomes
Health-related quality of life
Reference | TEVAR patients | P-value | |
---|---|---|---|
Dutch population (age 35–45)a | 0.94 (0.18) | 0.69 (0.31) | < 0.01 |
General trauma population UMCUb | 0.74 (0.31) | 0.69 (0.31) | 0.61 |