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Survival after certain aortic injuries improved
Mortality after blunt aortic and inferior vena cava injuries has declined over time in the U.S., accompanied by an increase in endovascular procedures, according to findings published in the Journal of Vascular Surgery.
However, among patients with aortic or IVC injuries with penetrating trauma, mortality increased over time and endovascular use did not meaningfully change, the researchers wrote.
The researchers analyzed 25,428 patients (mean age, 40 years; 70% men) from the National Trauma Databank who sustained IVC, abdominal aortic or thoracic aortic injuries between 2002 and 2014.
Among the cohort, 14.1% had a penetrating trauma, Bernardino C. Branco, MD, from the division of vascular surgery and endovascular therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and colleagues wrote.
Although the incidence of all three injuries remained constant during the study period, for patients with blunt trauma, mortality decreased from 48.8% in 2002 to 28.7% in 2014 (P < .001), driven by reductions in mortality from abdominal aortic injuries (from 58.3% to 26.2%; P < .001) and from thoracic aortic injuries (from 46.1% to 23.7%; P < .001), according to the researchers.
Among patients with blunt trauma, endovascular procedures increased from 1% in 2002 to 30.4% in 2014 (P < .001), Branco and colleagues wrote.
For patients with penetrating trauma, mortality increased from 43.8% in 2002 to 50.6% in 2014 (P < .001), driven by an increase in mortality from abdominal aortic injuries (from 30.4% to 66%; P < .001), they wrote.
Endovascular use in procedures to treat penetrating trauma was 0.1% in 2002 and 3.4% in 2014.
For patients with IVC injuries, there was a modest decrease in mortality for blunt trauma (2002, 51%; 2014, 49.7%; P < .001) but a jump in mortality for penetrating trauma (2002, 40.8%; 2014, 47.8%; P < .001), according to the researchers.
“Overall, despite a statistically significant decrease in mortality after blunt IVC and aortic injuries accompanied by an increase in use of endovascular procedures, death rates remained high, especially for IVC injuries,” Branco and colleagues wrote. “After penetrating trauma, mortality has increased in particular after abdominal aortic injury, with no clinically significant increase in endovascular use over the study period.” – by Erik Swain
Disclosure: The authors report no relevant financial disclosures.