Endovascular repair of traumatic descending aortic transection.
OBJECTIVE
To present the results of endovascular repair of acute traumatic descending aortic transection.


METHODS
Among 66 thoracic stent-graft repairs performed between 1995 and 2001, 11 patients (9 men; mean age 34 years, range 12-73) underwent emergent endovascular repair of acute traumatic descending aortic transection following traffic accidents. Immediate treatment of aortic rupture was indicated in all patients because of a marked fresh hematoma with hemothorax; the spiral computed tomographic (CT) scans showed circular or semicircular descending thoracic aortic injuries. The devices used included 11 thoracic Excluders and 1 Talent stent-graft.


RESULTS
No patient required conversion to an open transthoracic operation. No patient developed temporary or permanent neurological deficit after endovascular treatment. Two type I endoleaks required periprocedural treatment: a second stent-graft was deployed in one and the existing stent-graft was balloon dilated in the other. Two patients underwent secondary procedures (iliac access complication and revascularization of the left subclavian artery). One patient died 22 days postoperatively secondary to injuries unrelated to the aortic repair. Over a mean 14-month follow-up (range 1-26), the surveillance CT scans have shown the stent-graft to be correctly positioned in all patients.


CONCLUSIONS
The treatment of acute traumatic descending aortic transection with an endovascular approach is feasible and safe and may offer the best means of therapy. Mortality and the risk of neurological deficit are low compared with open operations.
Orend
Karl Heinz
KH
Department of Thoracic and Vascular Surgery, University of Ulm, Germany. karl-heinz.orend@medizin.uni-ulm.de
Pamler
Reinhard
R
Kapfer
Xaver
X
Liewald
Florian
F
Görich
Johannes
J
Sunder-Plassmann
Ludger
L
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*