title: An IVUS-based approach to traumatic aortic rupture, with a look at the lesion from inside.
abstract: OBJECTIVE
  To review a single-institution experience with endovascular repair of acute traumatic aortic rupture (ATAR) performed on an emergency basis using intravascular ultrasound (IVUS) exclusively as the navigation tool for stent-graft implantation (no arteriography).
  
  
  METHODS
  Between September 1998 and November 2006, 26 consecutive patients (19 men; mean age 38+/-19 years, range 15 to 83) underwent endovascular repair of ATAR performed by a surgical team using IVUS and fluoroscopy for lesion characterization and stent-graft deployment guidance. Transesophageal echocardiography was routinely used in all patients to visualize the aortic lesion and rule out residual flow after device deployment. Sealing of the aortic tear was evaluated by postoperative contrast-enhanced computed tomography.
  
  
  RESULTS
  IVUS revealed an extensive disruption of the tunica intima and media (>180 degrees ) in 46% (12/26) of patients; the disruption was circumferential in 3 cases, with pseudocoarctation. The aortic diameter at the site of rupture measured 24+/-4 mm. Primary technical success was 92% (24/26); 1 persistent but small proximal endoleak and an intraoperative death (4% in-hospital mortality) from abdominal bleeding in an octogenarian accounted for the failures. Procedure-related complications (2, 8%) included the aforementioned endoleak and a minor stroke secondary to cerebral embolization. There was no paraplegia associated with the repairs.
  
  
  CONCLUSIONS
  Endovascular repair of acute traumatic aortic disruption yields promising results, with high technical success and minimal procedure-related morbidity. IVUS as the primary navigation tool for device implantation allows prompt endovascular setup, instant aortic measurements, and precise visualization of the aortic disruption.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland. martyb@hopcantfr.ch
authors.forename: Bettina
authors.initials: B
authors.lastname: Marty
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
authors.forename: Patrick
authors.initials: P
authors.lastname: Ruchat
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.forename: Francesco
authors.initials: F
authors.lastname: Doenz
authors.forename: Ludwig Karl
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D000328:Adult; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D017548:Echocardiography, Transesophageal; D004632:Emergency Medical Services; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014947:Wounds and Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery