[Indication of endovascular stent grafts for traumatic rupture of the thoracic aorta].
OBJECTIVE
The usual treatment of traumatic aortic rupture (TAR) is surgical. This invasive technique necessitating thoracotomy and ECC is associated with a mortality rate of more than 20% and a paraplegia risk of about 10%. New minimally-invasive techniques (aortic stent-grafting) are emerging as less risky alternatives to surgery. We report our experience in the percutaneous treatment of TAR with stent-graft via a surgical femoral cut-down.


METHODS
Between 1996 and 2002, 23 patients (16-65-year-old, mean 36 years) were treated by thoracic stent-grafting. An informed consent was obtained for every patients. Thirteen patients had an acute or sub-acute TAR (1-8 months, mean 5 months) and five patients had chronic TAR (13-24 years, mean 17 years). The technique was done under general anaesthesia and each patient received a preoperative blood-pressure reduction treatment. During the procedure, anticoagulation (heparin) was given and hypotension was induced when the stent-graft was deployed. Direct positioning control was obtained by means of TEE.


RESULTS
Eighty percent of patients were extubed immediately after the procedure. Bleeding was <150 ml. The primary success rate was 100% with one minor type 2 endoleak that was spontaneously resolved after 2 months. There was no case of mortality or paraplegia. There were three minor complications (17%), two haematomas at the arteriotomy site and one inflammatory syndrome characterised by slight fever, raised biological markers but with negative blood culture.


CONCLUSIONS
Percutaneous aortic stent-grafting for TAR is a minimally-invasive technique, which constitute an interesting alternative to surgery. It only necessitates a femoral surgical cut-down compared to the thoracotomy and ECC associated with surgery. The complication rate is low and no mortality or major complication was encountered in our patients. Eventually, the long-term follow-up will allow a widening of indications.
Service d'anesthésie-réanimation, hôpital Rangueil, 31403 Toulouse cedex, France. meites.g@chu-toulouse.fr
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G
Meites
C
C
Conil
H
H
Rousseau
V
V
Chabbert
C
C
Cron
C
C
Dambrin
K
K
Samii
C
C
Virenque
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000925:Anticoagulants / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012421:Rupture / Q000401:mortality / Q000601:surgery; D015607:Stents; D014656:Vascular Surgical Procedures / Q000009:adverse effects
D000925:Anticoagulants; D006493:Heparin