Best way to treat blunt trauma injuries.

Endovascular repair--fixing an injury to a blood vessel from inside that vessel--is a better option for individuals who receive highly lethal injuries from falls or high-speed collisions (together referred to as blunt trauma) and is shown to save more lives and nearly eliminate paraplegia (the loss of the ability to move or feel both legs), a complication of surgical repair for thoracic aortic aneurysms, according to a study by the Society of Interventional Radiology, Fairfax, Va.

"Analysis of the available data provides unequivocal support for endovascular repair to replace open surgery as the procedure of choice for repair of the most common traumatic aortic injury," points out Eric K. Hoffer, director of Vascular and Interventional Radiology at Dartmouth Medical School, Hanover, N.H. "This minimally invasive interventional radiology technique can decrease the death rate by half and diminish the risk of paraplegia by 75% as compared to open surgical repair."

Injuries causing thoracic (chest) aortic trauma are life-threatening, often resulting in significant disability or death. Injuries to the body's largest artery account for as much as 25% of all motor vehicle trauma-related deaths, and most of these individuals die at the scene of the injury, notes Hoffer. The 10-20% who survive and make it to the hospital may die within hours of admittance. These injuries may cause partial tears of the artery wall and might not be obvious initially. If left untreated, the artery could expand and eventually rupture, resulting in massive bleeding into the chest that invariably is fatal, warns Hoffer.

During surgery, a patient is at increased risk of paraplegia because the thoracic aorta is clamped, cutting off blood to the spinal column, Hoffer explains. The interventional radiology treatment does not interrupt blood supply. By entering a branch of the aorta through a small incision in the groin and using long, thin tubes called catheters, interventional radiologists guide and deliver a stent graft (a tube composed of fabric supported by a metal mesh) through the blood vessels. When expanded with the artery, the stent graft bridges the injury, reinforcing an artery's weak spot, or tear, and, when successful, eliminates the risk of continued expansion and rupture. This provides a less invasive option with reduced pain and recovery time, and a lower risk of complications than open surgery.

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In the study, the "endovascular advantage" was demonstrated in relation to contemporary intensive care and surgical methods, which over the past 30 years decreased operative mortality rates from 45-80% to 1828%. Endograft repair further reduced mortality to eight to nine percent. The improved survival rate "may be a result of the decreased systemic stress that endovascular repair affords,"' theorizes Hoffer, "which is important with this group of patients where additional severe injuries are common."