Endovascular Management of Traumatic Thoracic Aortic Transection

Abstract

The conventional treatment of traumatic thoracic aortic transection is open surgical repair but it is associated with high rates of morbidity and mortality, particularly in patients with multiple injuries. We reviewed our experience of endovascular repair of traumatic thoracic aortic transection. Between March 2002 and December 2007, 7 patients (male 6, female 1; mean age 40 years) with multiple injuries secondary to blunt trauma underwent endovascular stenting. One patient required adjunctive surgery to facilitate endovascular stenting. Mean intensive care unit stay was 8.6 days (range, 3-16 days). Arterial access in all patients was obtained by femoral cut-down. The mean operating time was 122 min. Technical success was achieved in all cases. There was no mortality. One patient suffered a right parietal stroke, but none developed procedure-related paralysis. The mean follow-up period was 18.6 months (range, 6-48 months). There was no evidence of endoleak, stent migration, or late pseudoaneurysm formation on follow-up computed tomography. Endovascular stents can be used to treat traumatic thoracic aortic transection, with low rates of morbidity and mortality. Although early and midterm results are promising, the long-term durability of endovascular stenting for traumatic thoracic aortic transection remains unknown.

Treatment of blunt thoracic aortic injury in Germany—Assessment of the TraumaRegister DGU®

“…Nowadays, multiple single-center studies with numbers of patients between 7 and more than 50 demonstrated the benefits of the endovascular approach [21, 22]. If existing, a comparison with the open surgical treatment is mainly based on small numbers of patients.…”

Endovascular treatment for acute traumatic thoracic aortic transection

“…[2] In high impact motor vehicle accidents, rapid deceleration causes aortic arch injury mostly at the level of the isthmus. [5] Patients with aortic injury also have concomitant traumas. It is important to evaluate whether hemodynamic instability is aorta-related or not.…”

Treatment of patients with posttraumatic aortic pseudocoarctation syndrome

“…Имплантация покрытого тканью нитенолового про-теза (стент-графта) при аневризме грудного отдела аорты выполняется с конца 80-х годов прошлого века как у нас в стране, так и за рубежом [3] и является достаточно эффек-тивной и безопасной процедурой [1, 5,6]. Чрезбедренный доступ существенно уменьшает интраоперационное по-вреждение тканей и сроки реабилитации пациента, что позволяет сконцентрироваться на лечении других прояв-лений политравмы [1].…”