Endovascular treatment of acute aortic isthmic rupture: concerning midterm results.
BACKGROUND
We evaluated midterm results of endovascular management of traumatic aortic isthmic ruptures.


METHODS
Between 2001 and 2008, 10 patients (seven males, mean age 38 years) underwent endovascular treatment of an acute aortic rupture. Eight procedures were emergent, with four cases of hemodynamic instability with Glasgow scores of 3, 5, and 7. Associated traumas were severe brain, liver, and pelvic bone injuries. All procedures were performed with transoesophageal echocardiography monitoring. We used two AneuRx and nine Medtronic Talent or Valiant stent grafts.


RESULTS
All patients survived their traumatic isthmic rupture. In nine patients, stent-graft deployment was successful. One patient experienced a distal migration needing a laparotomy and deployment of an additional new thoracic stent graft. The mean intensive care unit stay was 48 hr (range 24-168). The mean hospital stay was 11 days (range 8-43). All patients were controlled clinically and by contrast computed tomography (CT) according to the EUROSTAR protocol. There were no endoleaks, stent graft-related complications, or late deaths during a mean follow-up of 49 months. The control CT showed a lack of apposition of the proximal part of the stent graft at the inner curve of the aortic arch in three patients.


CONCLUSIONS
The midterm results of endovascular treatment of acute traumatic aortic isthmic rupture are encouraging and compare favorably to the surgical approach. Late follow-up is required to exclude possible stent-graft complications, especially in young patients with angulated aortic arches.
Astarci
P
P
Cardiovascular Surgery Department, Saint-Luc University Hospital, Brussels, Belgium. parla.astarci@chir.ucl.ac.be
Lacroix
V
V
Glineur
D
D
Poncelet
A
A
Rubay
J
J
El Khoury
G
G
Noirhomme
P
P
Verhels
R
R
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D003422:Critical Care; D017548:Echocardiography, Transesophageal; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult