1. Department of Cardiothoracic and Vascular Surgery 1 School of Public Health 2 The University of Texas Medical School at Houston Memorial Hermann Heart & Vascular Institute A. Azizzadeh MD 1, K.M. Charlton-Ouw MD 1 Z. Chen MD 1, A.L. Estrera MD 1, S.M. Coogan MD 1, M.H. Rahbar PhD 2, H.J. Safi MD 1 An Outcome Analysis of Endovascular vs. Open Repair of Blunt Traumatic Aortic Injuries

2. Purpose To evaluate the outcomes of TEVAR vs. OR for pts with TAI

3. Methods  From 4/2002 to 6/2010  Urban level 1 trauma center  Prospectively collected data from the institutional trauma registry  Retrospective review of hospital financial accounts Primary:  Mortality (In-Hospital)  Complications Secondary:  Cost  Intensive care unit (ICU) LOS  Pre-operative LOS  Post-operative LOS  Total hospital LOS

5. Results  4/ 2002 to 6/ 2010  106 patients with TAI 74 32  Mean Age: 36.4 yrs

6. VARIABLEOR (N=56) TEVAR (N=50) p-value Male N (%)39 (69.6)35 (70.0)1.00 Age Mean (sd)32.16 (14.23)41.06 (20.32)0.01 ISS mean (sd)37.96 (9.98)36.68 (9.81)0.51 GCS2 mean (sd)11.11 (5.28)10.94 (5.19)0.87 RPS2 mean (sd)0.76 (0.30)0.73 (0.29)0.57 TAI mean (sd)2.71 (0.49)2.72 (0.36)0.95 Baseline Characteristics

7. Operative Data Open Repair:  N=56  Tech Success: 98.2%  Operative Mortality: 0% TEVAR:  N=50  Tech Success: 100%  Operative Mortality: 0%  Devices (N=52)  TAG (WL Gore), N=33  Talent (Medtronic), N=18  Other (WL Gore), N=1

8. VARIABLEOR (N=56) TEVAR (N=50) Adjusted OR (95% CI) (TEVAR vs. OR) p-value Total Complications N (%)39 (69.64)24 (48.00)0.33 (0.11, 0.97)0.045 No. of Complications (Mean) 1.210.89NA*0.020 Complications + Mortality N (%) 39 (69.64)24 (48.00)0.33 (0.11,0.97)0.045 Total No. of Complications+ Mortality (mean) 1.290.94NA*0.030 Primary Outcomes

9. VARIABLE OR (N=56) mean TEVAR (N=50) mean p-value Cost-variable51356818000.017 Cost-fixed18913237280.18 Cost-total969441079970.52 Cost VARIABLE OR (N=56) mean TEVAR (N=50) mean p-value ICU LOS17.4315.580.54 Pre-op LOS3.009.820.022 Post-op LOS28.7315.740.0021 Total LOS31.7425.570.19 Length of Stay

10. TEVAR Follow Up Imaging Protocol  CTA  1 month  6 months  12 months  Yearly  Compliance 32%

11. Survival Distribution

12. Conclusion  OR pts 3x more likely to have complications or mortality  The cost of TEVAR was NOT significantly different than OR  Findings support use of TEVAR for pts with TAI