title: Endovascular repair of thoracic aortic tears.
abstract: BACKGROUND
  Standard treatment of traumatic thoracic aortic transection (TTAT) is open repair by left thoracotomy with or without the use of partial cardiopulmonary bypass. However, open repair is associated with high rates of morbidity and mortality, particularly in multiply injured trauma patients. We reviewed our experiences of endovascular repair of acute TTAT.
  
  
  METHODS
  Between February 2001 and February 2006, 30 patients (male 24, female 6, mean age 43 years) who had sustained severe blunt trauma with multiple injuries (mean injury severity score = 42) underwent endovascular repair for TTAT. Devices used included commercially available proximal abdominal aortic extension cuffs and thoracic stent-grafts. Either low dose or no systemic heparin was used. Arterial access was obtained by femoral-iliac cutdown (n = 19) or completely percutaneous through the femoral artery (n = 11). Mean follow-up was 11.6 months (range, 1 to 48 months).
  
  
  RESULTS
  Technically success was achieved in 100% of patients, as determined by angiographic and computed tomographic (CT) scan exclusion of TTAT. Mean operating time was 132 minutes. Mean blood loss was 300 cm3. Three patients had complications: 1 iliac artery rupture, 1 cerebellar stroke, and 1 partial stent collapse. There were 2 perioperative deaths. There were no instances of procedure-related paralysis. Clinical and CT follow-up did not reveal evidence of endoleak, stent migration, or late pseudoaneurysm formation.
  
  
  CONCLUSIONS
  The adaptation of commercially available stent-graft devices to treat TTAT is technically feasible, and can be performed with low rates of morbidity and mortality. The long-term durability of endovascular repair of TTAT remains unknown, but early and midterm results appear promising.
authors.affiliation: Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida 33136, USA. htehrani@med.miami.edu
authors.forename: Hassan Y
authors.initials: HY
authors.lastname: Tehrani
authors.forename: Brian G
authors.initials: BG
authors.lastname: Peterson
authors.forename: Kushagra
authors.initials: K
authors.lastname: Katariya
authors.forename: Mark D
authors.initials: MD
authors.lastname: Morasch
authors.forename: Randy
authors.initials: R
authors.lastname: Stevens
authors.forename: Gabrielle
authors.initials: G
authors.lastname: DiLuozzo
authors.forename: Tomas
authors.initials: T
authors.lastname: Salerno
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maurici
authors.forename: Darwin
authors.initials: D
authors.lastname: Eton
authors.forename: Mark K
authors.initials: MK
authors.lastname: Eskandari
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D011183:Postoperative Complications / Q000453:epidemiology; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents; D014656:Vascular Surgical Procedures / Q000295:instrumentation; D014949:Wounds, Nonpenetrating / Q000601:surgery