Endovascular repair of thoracic aortic tears.
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.
Tehrani
Hassan Y
HY
Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida 33136, USA. htehrani@med.miami.edu
Peterson
Brian G
BG
Katariya
Kushagra
K
Morasch
Mark D
MD
Stevens
Randy
R
DiLuozzo
Gabrielle
G
Salerno
Tomas
T
Maurici
Giuseppe
G
Eton
Darwin
D
Eskandari
Mark K
MK
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