M. Moore1, M. B. LaPlant1, B. J. Segura1, D. J. Hess1, D. A. Saltzman1 1University Of Minnesota,Pediatric Surgery/Pediatric Surgery/Medical School,Minneapolis, MN, USA
Introduction: Traumatic thoracic aortic injuries are relatively rare within the pediatric population, occurring in only 0.06% to 0.1% of patients. Though infrequent, these injuries contribute to 2.1% of pediatric trauma related deaths. Thoracic aortic injuries are most frequently due to high energy, blunt trauma, with motor vehicle accidents and falls being the most common mechanisms. Endovascular repair of traumatic aortic injuries has become more common in the adult population where it has demonstrated a survival benefit and decreased morbidities in comparison to an open approach. In a previous study of all types of arterial injuries in pediatric trauma patients, there was no mortality difference between endovascular and open approaches. We aim to compare outcomes between endovascular and open management of traumatic thoracic aortic injuries in pediatric patients.
Methods: We selected records from the National Trauma Databank, years 2010 – 2016. Included in analysis were all patients, aged 1 to 18 years, with a thoracic aorta injury who had endovascular repair (n = 92) or open repair (n = 93). We compared hospital mortality by treatment approach using fisher’s exact test and logistic regression, adjusting for patient demographics, injury severity, injury type, facility type, and facility clustering.
Results: Patients ranged in age from three to 17 years (mean 15; SD 2.8). Injury severity scores ranged from 16 to 75 (mean 37; SD 15.0), and 85% of injuries were blunt. The mortality rate for patients who underwent endovascular repair was 6.5%, compared to 30.1% for patients that underwent open repair (p < .001). The mortality odds remained significantly higher for open approach patients after adjusting for patient and facility characteristics (AOR 5.89; 95% CI 1.32 – 26.28; p .021).
Conclusion: Endovascular interventions are increasingly common in the management of trauma, but require further evaluation in pediatric patients. Mortality was significantly higher for pediatric patients who underwent open repair of thoracic aortic injuries, as compared to endovascular repair. After adjusting for patient and facility characteristics, the mortality odds remained significantly higher for patients undergoing an open approach. The use of endovascular approach for thoracic aorta repair may be efficacious and beneficial in pediatric patients. As endovascular therapy becomes widely available, it is important to characterize further the populations and types of injuries that will benefit from this approach.