Blunt aortic (BAI) and traumatic brain injury (TBI) are the leading causes of death after blunt trauma. The purpose of this study was to identify predictors of mortality for BAI and to examine the impact of procedural heparinization during thoracic endovascular aortic repair (TEVAR) on neurologic outcomes in patients with BAI/TBI.
BAI patients over 8-years were identified. Age, gender, severity of injury and shock, time to TEVAR, morbidity and mortality were recorded and compared. Multivariable logistic regression (MLR) was performed to determine independent predictors of mortality. Youden’s index determined optimal time to TEVAR.
129 patients were identified. The majority (74%) were male with a median age and ISS of 40 and 29, respectively. Of these, 26 (20%) had a concomitant TBI. BAI/TBI patients had higher injury burden at presentation (ISS 37 vs. 29, p=0.002; GCS 6 vs 15, p<0.0001), underwent fewer TEVAR procedures (31% vs. 53%, p=0.039) and suffered increased mortality (39% vs. 16%, p=0.009). All TEVARs had procedural anticoagulation, including TBI patients, without change in neurologic function. The optimal time to TEVAR was 14.8 hours. Mortality increased in TEVAR patients prior to 14.8 hours (8.7% vs 0%, p=0.210). MLR identified TEVAR as the only modifiable factor that reduced mortality (OR 0.11; 95%CI 0.03-0.45, p=0.002).
TEVAR use was identified as the only modifiable predictor of reduced mortality in patients with BAI. Delayed TEVAR with use of procedural heparin provides a safe option regardless of TBI with improved survival and no difference in discharge neurologic function.

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