Mid-term results of conservative, conventional and endovascular treatment for acute traumatic aortic lesions.
BACKGROUND
To analyze our results after conservative, conventional and endovascular treatment for acute traumatic aortic lesions during the last decade.


METHODS
From June 1993 to September 2004, a total of 19 patients with traumatic aortic lesions were referred to our department. All patients sustained injuries from blunt deceleration trauma. In hemodynamically stable patients, initial evaluation was by multi-slice CT scan. The diagnosis of traumatic aortic injury was confirmed and an individual treatment strategy was determined. In hemodynamically unstable patients, emergency thoracotomy was performed.


RESULTS
An emergency thoracotomy was performed in seven (37%) patients. Mortality in this group was 100%. In the remaining group of 12 (63%) patients without hemodynamic instability at time of admission, in-hospital mortality was 0%. Treatment was surgical in five patients (26%), endovascular in five (26%) and conservative in two patients (11%). Mean follow-up was 63 months (5-108 months). No patient died during follow-up. In patients treated by endovascular stent-graft placement no signs of endoleaks could be detected.


CONCLUSIONS
Hemodynamic stability and an individual treatment strategy are prerequisites for survival of acute traumatic aortic lesions. Endovascular stent-graft placement has emerged as an innovative and minimally invasive therapeutic option in this polytraumatic high-risk patient cohort.
Stampfl
P
P
Department of Traumatology, University of Vienna Medical School, Vienna, Austria.
Greitbauer
M
M
Zimpfer
D
D
Fleck
T
T
Schoder
M
M
Lammer
J
J
Wolner
E
E
Grimm
M
M
Vécsei
V
V
Czerny
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D001011:Aorta / Q000293:injuries*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D013908:Thoracotomy; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014949:Wounds, Nonpenetrating / Q000628:therapy*
D014665:Vasodilator Agents