title: Endovascular management of traumatic thoracic aortic injuries.
abstract: BACKGROUND
  Endovascular surgery has recently been extended to the treatment of blunt traumatic aortic injuries. Since most of these injuries occur at the aortic isthmus, graft fixation in proximity to the origin of the left subclavian artery (LSA) has been a concern. Covering the LSA with graft fabric lengthens the proximal fixation site and should minimize proximal endoleaks. We therefore wished to evaluate the feasibility and safety of endovascular repair of thoracic aortic injuries after blunt trauma, both with and without deliberate coverage of the LSA.
  
  
  METHODS
  At a tertiary care teaching hospital in London, Ont., we reviewed our experience with endovascular repair of 7 traumatic aortic injuries. We reviewed the technical success rate and the incidence of left subclavian coverage. Major morbidity, including rates of paraplegia and death were noted. The patients were followed-up with serial CT to look for endoleaks, stent migration or aneurysm growth and to determine whether they had symptoms related to left subclavian coverage.
  
  
  RESULTS
  The time from injury to treatment ranged from 7 hours to 7 days (mean 36 h). The mean Injury Severity Score was 36. All injuries were at the aortic isthmus, and among the 7 patients treated, 6 had deliberate coverage of the LSA. One patient underwent carotid-to-subclavian artery bypass, but the other 5 did not. There were no cases of paraplegia; 1 patient had symptoms of claudication in the left arm but did not want revascularization. No procedure-related complications occurred, and all patients survived the event. Follow-up ranged from 2 to 30 (mean 13) months, and no endoleaks, stent migration or aneurysm expansion were noted in follow-up.
  
  
  CONCLUSIONS
  Although long-term results are unknown, we conclude that endovascular repair of traumatic aortic injuries after blunt trauma can be performed safely with low morbidity and mortality and that coverage of the LSA without revascularization is tolerated by most patients.
authors.affiliation: Division of Vascular Surgery, University of Western Ontario, London, ON. klawlor@uwo.ca
authors.forename: D Kirk
authors.initials: DK
authors.lastname: Lawlor
authors.forename: Michael
authors.initials: M
authors.lastname: Ott
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Forbes
authors.forename: Stewart
authors.initials: S
authors.lastname: Kribs
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Harris
authors.forename: Guy
authors.initials: G
authors.lastname: DeRose
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000379:methods; D001013:Aorta, Thoracic; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000601:surgery; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery*