Acute traumatic aortic tear: open versus stent-graft repair.
Acute traumatic aortic tear (ATAT) is the second most common cause of deaths in trauma patients (about 8,000 deaths/year in the USA). Due to circumferential aortic disruption, up to 90% die at the scene. Responsible trauma mechanisms are: penetrating (gunshot/stab wounds), iatrogenic (interventional catheterization) and, most frequently, blunt chest trauma (high-speed motor vehicles, falls from heights, crushes, explosions) resulting in injury at the aortic isthmus region (loco typico, about 90%). Severe multiple system injuries (polytrauma), especially to intracranial and intraabdominal organs, are characteristic and prognostically predicitive. Immediate transthoracic open repair of ATAT has a mortality risk of 8% to 33% and paraplegia risk of 2% to 26%. Contrast enhanced CT scan has replaced the classical angiography as the diagnostic tool of choice. Patients with life-threatening multisystem injuries are scheduled for delayed repair after initial stabilization. Currently, the use of endovascular stent-grafts (EVAR) is being investigated. Our personal series confirms that EVAR for ATAT is a viable alternative to open repair while minimizing the morbidity and mortality of the open procedure and having a limited impact on trauma destabilization. The assessment of long-term durability of EVAR is one of the key issues to consider EVAR as the first choice of treatment.
Department of Vascular and Endovascular Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. schumacher@uni-hd.de
Hardy
H
Schumacher
Dittmar
D
Böckler
Hendrik
H
von Tengg-Kobligk
Jens-R
JR
Allenberg
D000465:Algorithms; D000792:Angiography; D001013:Aorta, Thoracic / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D001019:Aortic Rupture / Q000601:surgery / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002986:Clinical Trials as Topic; D006801:Humans; D011379:Prognosis; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods / Q000592:standards; D014949:Wounds, Nonpenetrating / Q000473:pathology / Q000628:therapy*