Endovascular repair for acute traumatic rupture of the thoracic aorta.
BACKGROUND
We report endovascular treatment of acute traumatic rupture of the thoracic aorta as a potential alternative to open surgery for high-risk patients.


METHODS
Between January 2001 and July 2002, 9 patients with acute traumatic rupture of the thoracic aorta were treated with a stent-graft. In all cases the endovascular management was selected because of age, associated polytrauma, or comorbidities. Preoperative workup included chest computed tomography scan, transoesophageal echography, and angiography. The devices used were the Excluder and the Talent stent-grafts.


RESULTS
Eight patients underwent immediate repair and 1 patient was treated within 5 days of the accident because of delayed diagnosis of aortic rupture after surgical management of spleen rupture. The stent-graft was successfully expanded in all patients through the common femoral artery (n = 7) or the common iliac artery (n = 2). There was no perioperative death, renal failure, or neurologic complication (paraplegia or stroke). In 1 patient the computed tomography scan at 7 days postoperatively showed proximal endoleak requiring placement of a second stent-graft. Follow-up ranged from 4 to 20 months. All spiral computed tomography scans performed during follow-up revealed no evidence of endoleak, migration, or alteration of the stent-graft.


CONCLUSIONS
Endovascular repair in the acute phase of traumatic rupture of the thoracic aorta is technically feasible and safe, and may represent an alternative to open surgery for high-risk patients.
Marty-Ané
Charles-Henri
CH
Service de Chirurgie Thoracique et Vasculaire, Hôpital Arnaud de Villeneuve, Montpellier, France. ch-marty_ane@chu-montpellier.fr
Berthet
Jean-Philippe
JP
Branchereau
Pascal
P
Mary
Henri
H
Alric
Pierre
P
D000208:Acute Disease; D000328:Adult; D000800:Angioplasty, Balloon; D001013:Aorta, Thoracic / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D001019:Aortic Rupture / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed