Curved nitinol stent-graft placement for treating blunt thoracic aortic injury: an early experience.
BACKGROUND
Blunt trauma-induced aortic injury traditionally has been treated with early open surgical repair. However, recently endovascular stent-graft technology is considered a less-invasive therapeutic alternative, and flexible stent-grafts, such as the Matsui-Kitamura stent-graft (MKSG), are being used widely. We report our experience with the curved MKSG in treating thoracic aortic injuries.


METHODS
Nine patients with traumatic thoracic aortic injury underwent endovascular surgery (8, emergency; 1, elective) with curved MKSG. The study variables were Injury Severity Score, endovascular surgery duration, aortic and stent-graft diameter, stay in the intensive care unit, follow-up period, and mortality. An MKSG was constructed using the Matsui-Kitamura stent and a polyester fabric graft. The stent-graft was placed using the transfemoral approach and the wire-tug technique.


RESULTS
The mean Injury Severity Score was 42.3; 5 patients required 6 emergency procedures before the endovascular procedure (pneumothorax or hemothorax drainage, 5; transarterial embolization, 1). In 8 patients (88.9%), we achieved complete pseudoaneurysm exclusion or hemostasis in the injured portion. There were no postoperative complications; blood loss was minimal, and the intensive care unit stay was 13.4 days. The overall hospital mortality was 22.2% (n = 2; causes of death were unrelated to MKSG placement). Neither intervention-related mortality during follow-up (mean, 237.7 days) nor late endovascular graft-related complications (endoleak or graft migration) were noted.


CONCLUSIONS
Although this study is limited by a small sample size and short follow-up period, no collapse or stent-graft fractures were noted. Thus, MKSG placement for traumatic thoracic aortic injury appears a safe and effective therapy.
Yamaguchi
Masato
M
Department of Radiology, Kobe Red Cross Hospital/Hyogo Emergency Medical Center, Kobe, Japan. masato03310402@yahoo.co.jp
Sugimoto
Koji
K
Tsukube
Takuro
T
Mori
Takeki
T
Kawahira
Toshihiro
T
Hayashi
Taro
T
Nakamura
Masahiko
M
Kawasaki
Ryota
R
Sandhu
Rajdeep S
RS
Sugimura
Kazuro
K
Kozawa
Syuichi
S
Okita
Yutaka
Y
D000328:Adult; D000368:Aged; D000497:Alloys; D017541:Aneurysm, False / Q000628:therapy; D001013:Aorta, Thoracic / Q000293:injuries*; D001807:Blood Vessel Prosthesis; D017558:Elective Surgical Procedures; D004630:Emergencies; D004867:Equipment Design; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D014949:Wounds, Nonpenetrating / Q000150:complications*
D000497:Alloys; C013616:nitinol