title: Acute traumatic aortic rupture: a comparison of surgical and stent-graft repair.
abstract: OBJECTIVE
  The study's objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture.
  
  
  METHODS
  A total of 76 patients (14-76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5-257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up.
  
  
  RESULTS
  In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13-90 months). No major complication was observed in group 3.
  
  
  CONCLUSIONS
  In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.
authors.affiliation: Department of Radiology, University Hospital Rangueil, 01 av. J Poulhes, 31403 Toulouse, France. rousseau.h@chu-toulouse.fr
authors.forename: H
authors.initials: H
authors.lastname: Rousseau
authors.forename: C
authors.initials: C
authors.lastname: Dambrin
authors.forename: B
authors.initials: B
authors.lastname: Marcheix
authors.forename: L
authors.initials: L
authors.lastname: Richeux
authors.forename: M
authors.initials: M
authors.lastname: Mazerolles
authors.forename: C
authors.initials: C
authors.lastname: Cron
authors.forename: A
authors.initials: A
authors.lastname: Watkinson
authors.forename: A
authors.initials: A
authors.lastname: Mugniot
authors.forename: P
authors.initials: P
authors.lastname: Soula
authors.forename: V
authors.initials: V
authors.lastname: Chabbert
authors.forename: G
authors.initials: G
authors.lastname: Canevet
authors.forename: D
authors.initials: D
authors.lastname: Roux
authors.forename: P
authors.initials: P
authors.lastname: Massabuau
authors.forename: G
authors.initials: G
authors.lastname: Meites
authors.forename: T
authors.initials: T
authors.lastname: Tran Van
authors.forename: P
authors.initials: P
authors.lastname: Otal
mesh_terms: D000063:Accidents, Traffic; D000208:Acute Disease; D000704:Analysis of Variance; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D001013:Aorta, Thoracic / Q000293:injuries*; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013908:Thoracotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D013997:Time Factors; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications*