title: Immediate endovascular repair for acute traumatic injuries of the thoracic aorta: a multicenter analysis of 28 cases.
abstract: OBJECTIVE
  Endovascular repair of injured thoracic aorta offers a new minimal invasive therapeutic option that could be beneficial in the urgent management of polytrauma patients. The aim of this study was to assess our multicenter experience of immediate endovascular repair for acute traumatic injuries of the thoracic aorta.
  
  
  METHODS
  Between April 2002 and October 2007, all patients treated for an acute traumatic injury of the thoracic aorta, in a less than 12-hour delay, by endovascular repair, were reviewed retrospectively in three Parisian trauma centers. Collected data included age, sex, associated comorbidities, and traumatic lesions to determine the Traumatic Injury Severity Score (TRISS), the type of aortic lesion assessed by computed tomography (CT)-scan and transesophageal ultrasonography, technical aspects of endovascular repair, length of hospital stay, and postoperative mortality. Patients were regularly followed by clinical examination, chest radiographs, and thoracic CT-scan.
  
  
  RESULTS
  Twenty-eight patients (20 males, mean age 45 +/- 18.8 years) were treated in a median delay of 5 hours (range 2 to 10 hours) after initial trauma. They all experienced severe traumatic injuries with a mean predictive mortality of 55.6% +/- 33.1% according to TRISS. Aortic lesions were associated with aortic parietal hematoma (71%), hemomediastinum (86%), and hemothorax (68%). All endovascular procedures were technically successful through femoral (n = 24) or iliac access (n = 4), in a mean operating time of 94 +/- 35.8 minutes. Proximal sealing of the endografts required the coverage of the origin of the left subclavian artery in 13 cases and of the left common carotid in one case. The median of hospital stay was 27 days (range 9 to 127 days), with an overall hospital mortality of 17.9% (n = 5). All deaths were unrelated to the aortic rupture or the stent placement, and no intervention-related morbidity or mortality was recorded during a median follow-up of 24 months (range 5 to 73 months).
  
  
  CONCLUSIONS
  Endovascular stent grafting allows an immediate efficient repair for acute traumatic injuries of the thoracic aorta. This early management is, however, associated with a high in-hospital mortality, related to the severe concomitant injuries of such unselected multitrauma patients.
authors.affiliation: Department of Vascular and Thoracic Surgery, Hôpital Bichat, AP-HP and University Paris-Diderot, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Alsac
authors.forename: Benoit
authors.initials: B
authors.lastname: Boura
authors.forename: Pascal
authors.initials: P
authors.lastname: Desgranges
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Fabiani
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Becquemin
authors.forename: Guy
authors.initials: G
authors.lastname: Leseche
mesh_terms: D000208:Acute Disease; D017546:Angioscopy / Q000379:methods*; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome