Emergency stent-graft placement for hemorrhage control in acute thoracic aortic rupture.
OBJECTIVE
To report mid-term results of stent-graft (SG) implantation in acute thoracic aortic rupture as alternative to conventional open surgery with its associated high morbidity and mortality rates.


METHODS
Out of a series of 69 patients undergoing thoracic aortic SG implantation since 1998, 24 (mean age 57+/-19 years, range 20-85-years-old) patients were treated on an emergency basis for hemorrhage control. The indication for SG placement was acute traumatic aortic rupture in 15 patients, type B dissection with contained rupture in 3 patients, penetrating aortic ulcer with periaortic hematoma in 3 patients, and thoracic aortic aneurysm rupture in 3 patients. Preoperative assessment was done by computed tomography (CT) scanning and echography. Patients were treated in the angiography suite by implantation of Excluder (n = 18) Talent (n = 4) Corvita (n = 1) and Vanguard (n = 1) self-expanding grafts. Local anesthesia was the most frequently used anaesthesiologic technique.


RESULTS
Technical success rate of SG deployment was 100%. The early postoperative mortality was 12.5% (3 of 24). One patient suffered temporary paraplegia (4%). There was no intervention-related mortality during the mean follow-up of 34.1 months. Two secondary endoleaks were successfully treated with additional SG placement at 2 and 12 months postoperative, respectively.


CONCLUSIONS
Emergency SG repair to control hemorrhage in patients with an acute thoracic aortic rupture is a less-invasive attractive and rational treatment option, especially if associated lesions or co-morbidity may interfere with the surgical outcome. Long-term follow-up results will be helpful to clarify procedure durability bounded by material failure and postoperative aneurysm or aortic wall remodelling.
Melnitchouk
Serguei
S
Clinic for Cardiovascular Surgery at Zurich University Hospital, Zurich, Switzerland. smelnitchouk@partners.org
Pfammatter
Thomas
T
Kadner
Alexander
A
Dave
Hitendu
H
Witzke
Herbert
H
Trentz
Otmar
O
Turina
Marko
M
Lachat
Mario
M
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery; D001019:Aortic Rupture / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004630:Emergencies; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome