Thoracic aortic emergencies: impact of endovascular surgery.
BACKGROUND
Conventional surgery for thoracic aortic emergencies, such as contained or free rupture of thoracic aortic aneurysms, acute type B dissections, and traumatic rupture of the thoracic aorta, is frequently associated with a high rate of mortality and morbidity. To obviate this risk, endovascular surgery is considered to be a valid alternative procedure.


METHODS
From March 2001 to July 2002, 15 of 22 patients with acute thoracic aortic syndromes were submitted to endovascular surgery: 3 patients (20%) for traumatic rupture, 4 patients (26.7%) for contained or free rupture of thoracic aortic aneurysm, and 8 patients (53.3%) for acute type B dissection evolving to rupture. Computed tomographic scan was diagnostic in all patients. The stent grafts were introduced through the femoral artery.


RESULTS
In the endovascular group there were no perioperative deaths or open conversions. The intraoperative angiography and computed tomographic scan performed on discharge showed no significant endoleaks and successful sealing of the aortic dissection. Average intensive care unit and hospital stay was 1.7 +/- 0.8 and 5.9 +/- 3.0 days. Follow-up ranged between 4 and 23 months and included clinical examinations and serial computed tomographic scan at 3, 6, and 12 months, and every 6 months thereafter. One 84-year-old patient with thoracic aortic aneurysm died of pneumonia 78 days after endovascular surgery. Only one type 1 endoleak was noted in the first patient with traumatic rupture, 3 months after the procedure.


CONCLUSIONS
Endovascular surgery is a safe technique, showing encouraging early and midterm results and allowing for prompt treatment of associated lesions in complex multitrauma patients.
Iannelli
Gabriele
G
Department of Cardiac Surgery, University "Federico II" of Naples, Naples, Italy. gabrieleiannelli@libero.it
Piscione
Federico
F
Di Tommaso
Luigi
L
Monaco
Mario
M
Chiariello
Massimo
M
Spampinato
Nicola
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D000800:Angioplasty, Balloon; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D012422:Rupture, Spontaneous; D015607:Stents; D015996:Survival Rate; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery*