Endovascular stent grafting for the treatment of blunt thoracic aortic injury.
OBJECTIVE
Recent advances of endovascular stent-grafting (ESG) provide a new therapeutic option with minimum surgical damage for blunt aortic injury (BAI) during its acute phase. To clarify the effectiveness of ESG for BAI, a prospective clinical study at a university hospital was conducted.


METHODS
All patients with blunt thoracic injury underwent thoracic contrast-enhanced computed tomographic (CT) scan. Six patients age 48.8 +/- 19.8 years, with Injury Severity Scores of 35.8 +/- 8.1, and with BAI were treated according to our protocol. The stent-graft covered by woven Dacron was placed at the injury site. Endoleakage was then checked by aortography and CT scan was again performed once a day on days 7 through 14.


RESULTS
All patients had injury of the aortic isthmus. ESG placement was performed within 8 hours after injury except in one (48 hours). The operating time was 159.5 +/- 21.1 minutes and bleeding volume was 105 +/- 26.6 mL. No endoleakage was found. Repeat CT scan revealed disappearance of hematoma. All patients except one had an event-free clinical course. One patient died because of rupture of the ascending aorta on day 6; however, autopsy revealed evidence of the healing process at the injury site sealed by ESG.


CONCLUSIONS
An ESG is a valid therapeutic option with minimal surgical invasion for patients with acute-phase aortic injury.
Department of Emergency and Critical Care Medicine, Tokyo Medical University, 6-7-1 Nishinjinku, Shinjuku-ku, Tokyo, Japan 160-0023. fujikawa@tokyo-med.ac.jp
T
T
Fujikawa
T
T
Yukioka
S
S
Ishimaru
M
M
Kanai
A
A
Muraoka
H
H
Sasaki
H
H
Honma
S
S
Koike
S
S
Kawaguchi
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic / Q000293:injuries*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery*