Objective: Early diagnosis and treatment is essential to improving survival in patients with blunt traumatic aortic injury (BTAI). Often, aortic surgical intervention may be delayed due to increased risk of bleeding with heparin, particularly in polytrauma victims. We believe surgical delay may be remedied by proceeding without heparinization. This study reviewed the outcome of patients subjected to Thoracic Endovascular Aortic Repair (TEVAR) under full, low dose and no intraoperative systemic heparinization.

Methods: 77 cases of confirmed BTAI were identified and retrospectively analyzed at a high-volume urban trauma center over a period of 15 years (March 2003 – September 2017). Patients were stratified into three groups based on the intraoperative use of heparin during TEVAR. Baseline characteristics including patient demographics, diagnostic laboratory data and imaging studies, operative reports, postoperative complications, embolic and bleeding outcomes and mortality data were reviewed.

Results: Of the 77 total patients that underwent TEVAR for BTAI, 42 subjects received full dose heparinization, 18 received low dose heparin and 17 had no use of systemic heparin. There was no significant difference regarding patient age, gender, BMI or smoking history. The most common mechanism of injury was motor vehicle collision. Grade III (Pseudoaneurysm) was the predominant type of BTAI (Full Heparin (FH) 69.0% vs Low Heparin (LH) 61.1% vs No Heparin (NH) 76.5%, p=.23). The mean interval between admission and repair was 3 times longer in the FH vs NH group (FH 2.33 vs NH .76, p=.091). The mean time in the ICU was shorter in the NH vs FH groups (15 days vs 26.21 days, p=.025). Thromboembolic, bleeding outcomes and mortality rates were comparable among all 3 groups. 57 patients continued follow-up for a mean time of 30.99 months.

Conclusion: Our study shows no statistically significant difference in outcomes between the heparinized and non-heparinized groups. The primary benefit of the NH group is seen in time to repair. Although not statistically significant, the mean time to repair was three times longer in the full heparin group Patients in the NH group also benefited from prompt intervention and treatment. Therefore, intraoperative heparinization in critically ill patients with BTAI undergoing TEVAR remains at the surgeon’s discretion; although the lack of heparinization appears to be a safe and potentially faster alternative, particularly in the polytrauma patient.