Endovascular repair of traumatic aortic transection

Abstract

The present study reports a single center experience and mid-term results of endovascular repair of acute aortic traumatic transection on an emergency basis, instead of open surgical management. From January 2005 to December 2008, 13 cases of traumatic aortic transection with serious comorbidities, which underwent repair with thoracic stent grafts at our institution, were reviewed. The mean patient age was 32.5+/-7.8 years. During the follow-up period of 25.5+/-12.8 months, 12 patients were alive and one patient died of associated injuries. There were no intraoperative deaths, no incidence of paraplegia and no procedure-related mortality. The blood loses during the procedure were minimal. The thoracic aortic grafts were larger than the thoracic aorta by 12.4+/-5.7%. Five cases required complete or partial coverage of the left subclavian artery. There were two cases of graft collapse, which were successfully treated by endovascular reintervention. Our results suggest that this approach is safe, effective and can be performed with low rates of morbidity and mortality, especially in respect of patients with multiple injuries. Although initial results are encouraging, close long-term follow-up and technical improvements of the stent grafts are required.

Endovascular treatment for acute traumatic thoracic aortic transection

“…Aortic transection is the second most common cause of death following head injury (intracranial hemorrhage) with a rate of occurrence between 13% and 20% after blunt trauma. [3,4] Most patients with acute traumatic aortic transection show no evidence of aortic injury until hemodynamic instability occurs. [2] In high impact motor vehicle accidents, rapid deceleration causes aortic arch injury mostly at the level of the isthmus.…”

“…Otherwise, non-aorta-related life threatening injuries must be treated first and endovascular repair is suggested to be performed within 24 hours. [4] While open surgical repair has been performed as conventional treatment of traumatic aortic transection for years, endovascular stents have started to be used with low rates of morbidity and mortality by the rapid development of aortic stent-grafts in the last two decades. [1] The first clinical experience of endovascular stent-grafting in abdominal aortic aneurysms was described in 1991 by Parodi et al [6] It is now a well-established method of treatment as an alternative to open surgery.…”

“…There are some clear advantages of endovascular treatment over open surgery, including avoidance of left thoracotomy, single lung ventilation, aortic cross-clamping and cardiopulmonary bypass, reduced surgery time and reduced blood loss. [2,4] Mortality rates of endovascular treatment are between 0% and 20%, which is more favorable when compared to open surgery. After open surgical repair of traumatic aortic injuries, 30-day mortality rates are between 15% and 50%.…”

“…[4] The low risk of paraplegia is an advantage of the endovascular procedure when compared with open surgery. [4] Other short-term complications of endovascular treatment include stroke, access-site complications, stent collapse and recurrent laryngeal nerve damage, with morbidity ranging 3% to 36%. [2] In a literature review, the incidence of stroke or transient ischemic attack has been reported as 1.2%.…”

“…[7] Rates of stent-graft collapse after endovascular treatment has been reported between 0.03% and 10% in the literature. [4] Excessive oversizing of the stent-graft and acute angle of the aortic arch are the factors that can lead to stent collapse. [4] Caudal migration of stent-graft can also occur with an incidence of 1% to 2.8%.…”