Thoracic endovascular aortic repair of traumatic injuries involving the descending thoracic aorta.
Acute traumatic thoracic aortic transection is a devastating injury that often occurs in the context of multiple associated traumatic injuries. Patients who survive the initial trauma and present to the hospital experience progressive hospital mortality and remain at risk for rupture of the contained injury. Conventional open surgical repair is regarded as a definitive form of treatment with long-term durability. Unfortunately, the stress subjected upon the multitrauma patient during the operative intervention is believed to contribute to considerable operative morbidity and mortality. Despite advancements in the management and treatment of this condition, hospital and operative mortality remains high. Thoracic endovascular aortic repair (TEVAR) has emerged as a viable alterative to conventional open repair for the treatment of these injuries. This less invasive form of therapy allows for a rapid stabilization of the aortic disruption without subjecting the patient to the physiologic stress of a major operative intervention. This may potentially translate into reductions in associated operative mortality and morbidity for this condition. This review highlights some of the anatomic and technical considerations regarding endovascular repair of traumatic thoracic aortic injuries, and reviews reported outcomes.
Riesenman
P J
PJ
Division of Vascular Surgery, Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC 27599-7212, USA.
Farber
M A
MA
D000208:Acute Disease; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D011183:Postoperative Complications; D015607:Stents; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014949:Wounds, Nonpenetrating / Q000601:surgery*