Emergency repair of traumatic aortic rupture: endovascular versus conventional open repair.
OBJECTIVE
Our objective was to compare early results of endovascular stenting for traumatic aortic rupture with conventional open repair.


METHODS
We conducted a retrospective review of consecutive cases of traumatic aortic rupture in a single institution from July 2000 to July 2006.


RESULTS
Fifteen cases were identified. The mean injury severity score was 43 +/- 10. Fourteen patients had the procedure within 24 hours of admission to the hospital. Seven patients underwent endovascular stenting and 8 underwent open repair. For endovascular stenting, there were no failed procedures, no periprocedural complications, and no periprocedural deaths. In 6 patients, there was no evidence of endoleak, stent migration, or late pseudoaneurysm formation. One patient required a second stent 2 years later to treat a stenosis in the original stent. For open repair, cardiopulmonary bypass was used in 7 of the 8 patients. Lower limb paraplegia developed postoperatively in 1 patient and another patient died of head injuries. There was a significant reduction in the mean duration of the procedure (2.2 +/- 0.90 vs 5 +/- 3.2 hours; P = 0.04), the mean intraoperative blood loss (311 +/- 20 vs 953 +/- 20 mL; P = .02), the mean number of units of blood and blood products used (0.43 +/- 1.1 vs 3 +/- 3 units; P = .026), and the mean dose of heparin required (5000 +/- 1700 vs 24,000 +/- 7500 IU; P = .001) in the endovascular stenting group. There was no difference in duration of ventilation, intensive treatment unit, or hospital stay.


CONCLUSIONS
Endovascular stenting is technically feasible and applicable to a range of cardiac patients. It takes less time than open repair, requires less heparin and blood products, and therefore simplifies management of other injuries. In hemodynamically stable patients, endovascular stenting is the treatment of choice for traumatic aortic rupture.
Akowuah
Enoch
E
Department of Cardiothoracic Surgery, Bristol Heart Institute at the Bristol Royal Infirmary, Bristol, United Kingdom.
Baumbach
Andreas
A
Wilde
Peter
P
Angelini
Gianni
G
Bryan
Alan J
AJ
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000293:injuries* / Q000601:surgery; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016009:Chi-Square Distribution; D003287:Contrast Media; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media