Current Management of Traumatic Rupture of the Descending Thoracic Aorta

Abstract

Traumatic rupture of the descending thoracic aorta remains a leading cause of death following major blunt trauma. Management has evolved from uniformly performing emergent open repair with clamp and sew technique to include open repair with mechanical circulatory support, medical management and most recently, endovascular repair. This latter approach appears, in the short term, to be associated with perhaps better outcome, but long term data is still accruing. While an attractive option, there are specific anatomic and physiologic factors to be considered in each individual case.

Endovascular Stent in Traumatic Thoracic Aortic Dissection

“…Although complications do not occur frequently, endoleak, stent collapse, subclavian occlusion, stroke, embolization, bronchial obstruction, implant syndrome, dissection, migration, and paralysis may develop. 4) In our cases, procedure-related complications did not develop. Blood flow to left subclavian artery was not disturbed by the endovascular stent.…”

“…Despite great achievements from endovascular stent grafts, several complications of endovascular stenting have remained. Although complications do not occur frequently, endoleak, stent collapse, subclavian occlusion, stroke, embolization, bronchial obstruction, implant syndrome, dissection, migration, and paralysis may develop 4). In our cases, procedure-related complications did not develop.…”

“…The trauma mechanisms described have included shear forces applied at the ligamentum arteriosum, acute compression by the diaphragm, torsion of the aorta, acute intravascular hypertension and/or compression of the aorta between the sternum and spine (osseous pinch). 4) 5) …”

Chimney parallel grafts and thoracic endovascular aortic repair for blunt traumatic thoracic aortic injuries: A systematic review

“…BTTAI is associated with a high mortality, previously quoted from 8–15% 26 up to 70–85% in others, 27 and it is the second most common cause of death following blunt mechanisms of injury. 28 Given the high surgical risk in this population, a minimally invasive technique is warranted.…”

Endovascular repair of blunt aortic injury in a patient with situs inversus and dextrocardia

“…The bare metal stent allows accurate placement in the proximal landing zone with a lower risk of compromise to the carotid artery. BAI typically occurs just distal to the subclavian artery, 3 which is frequently covered partially or completely after our endograft deployment. The angiograms after deployment for this particular patient (not available) showed unobstructed flow through the right subclavian artery.…”