Among patients with blunt abdominal traumas who could be managed conservatively, an increased probability of delayed intra-abdominal hemorrhage was observed in those who received thoracic endovascular aortic repair (TEVAR) for concomitant blunt thoracic aortic injuries (BTAIs), according to a study in the Journal of Endovascular Therapy.
Investigators retrospectively compared the probability of delayed intra-abdominal hemorrhage in patients with concomitant blunt abdominal trauma and BTAI between those with and without TEVAR from January 2015 to December 2019. Participants had concomitant blunt abdominal trauma and severe blunt chest trauma (chest Abbreviated Injury Scale score ≥3).
An adjusted multivariate logistic regression model was developed to assess whether each patient’s need for TEVAR independently affected delayed intra-abdominal hemorrhage. Covariables that could clinically affect delayed intra-abdominal hemorrhage were considered in propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) and adjusted for in the multivariate logistic regression model.
Outcome measurements included the probability of delayed intra-abdominal hemorrhage and delay in blood transfusion.
A total of 341 patients with blunt trauma with concomitant severe chest trauma and abdominal trauma that could be managed conservatively were evaluated, 26 patients had concomitant BTAI and blunt abdominal trauma, of whom 7 did not have TEVAR (mean age, 45.3 [SD, 22.2]; 100% men). Of the participants who had TEVAR (mean age, 42.6 [SD, 15.1] years; 89.5% men), 21.1% had delayed intra-abdominal hemorrhage and required hemostatic interventions, but none of those without TEVAR had delayed intra-abdominal hemorrhage. The difference was nonsignificant (P =.306). However, participants who had TEVAR had a significantly greater delayed need for blood transfusions vs those who did not have TEVAR (1118.4 mL vs 857.1 mL; P =.010).
The researchers then used the same selection criteria to identify 322 patients without TEVAR. The 2 groups had significantly different demographics and injury severities before matching. With use of PSM, 38 patients were identified for a balanced group. After matching, participants with TEVAR were more likely to require a blood transfusion 24 hours after presenting to the emergency department (1118.4±2241.9 mL vs 422.4±968.3 mL, P <.001) and were more likely to have delayed intra-abdominal hemorrhage (21.1% vs 5.3%, P <.001) vs those without TEVAR.
When IPTW was applied, patients with blunt abdominal trauma and TEVAR for BTAI were more likely to have a delayed need for a blood transfusion (977.5±1235.7 mL vs 713.8±544.8 mL, P =.010) and were more likely to have intra-abdominal hemorrhage (14.8% vs 5.9%, P =.009) compared with patients who did not have TEVAR.
Among all 341 patients in the multivariate logistic regression analysis, TEVAR for BTAI was an independent risk factor for delayed intra-abdominal hemorrhage (odds ratio, 10.534; 95% CI, 2.599-42.688; P <.001) after adjustment for other covariables.
The researchers noted that their findings were retrospectively based on a single institution with a small number of patients and without more detailed information available regarding patient care. In addition, participants with BTAI frequently are polytraumatized, no patients received nonheparinized TEVAR, and the control group included patients without BTAI.
“More attention should be given in patients with high-grade aortic injuries and concomitant abdominal trauma,” the study authors wrote.
Hsu T-A, Huang J-F, Kuo L-W, et al. Does thoracic endovascular aortic repair for blunt thoracic aortic injury increase the probability of delayed intra-abdominal hemorrhage in patients with concomitant blunt abdominal trauma? J Endovasc Ther. Published online October 10, 2022. doi: 10.1177/15266028221128200