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Invited Critique
October 2010October 18, 2010

Paradigm Shift in the Treatment of Blunt Aortic Injury: A Good Thing: Comment on “Thoracic Aortic Endografting for Trauma”

Author Affiliations

Author Affiliation: Methodist Cardiovascular Surgery Associates, The Methodist Hospital Physician Organization [[amp]] DeBakey Heart [[amp]] Vascular Center, Houston, Texas.

Arch Surg. 2010;145(10):1011-1012. doi:10.1001/archsurg.2010.195

The incidence of blunt vehicular trauma is on the rise worldwide, especially in emerging health care sectors. Although BAI occurs in less than 1% of motor vehicle crashes, it accounts for 16% of accident-related deaths, second only to head injuries. As highlighted by Propper and Clouse, much progress has occurred in the past 2 decades in the detection and management of BAI. Buoyed by the development of stent-graft technologies in general, and endografting for aortic aneurysmal disease in particular, endovascular repair has become the most common and, in fact, preferred treatment for BAI. Although randomized controlled trial data are unavailable, a prospective multicenter study (AAST2) and at least 3 meta-analyses of best available data have demonstrated significantly reduced mortality, paraplegia, and stroke rates with endovascular compared with open repair. Indeed, this paradigm shift has been a good thing for patients across the globe.