Endovascular grafts for treatment of traumatic injury to the aortic arch and great vessels.
BACKGROUND
Treatment of traumatic vascular injury using endovascular techniques has evolved as endovascular capabilities have advanced over the past several decades. Several endovascular techniques have been employed to address the challenges of traumatic arterial injury, including coil embolization and the use of stents, which may be either bare metal or covered with graft material. Compared with traditional surgical repair, endovascular stent grafting for the repair of traumatic arterial injury offers the advantage of decreased morbidity because a remote access site may be used, avoiding surgical dissection and lengthy operating times.


METHODS
A Medline (1995-2007) search was performed to find all studies discussing the use of endovascular means to treat supradiaphragmatic arterial trauma.


RESULTS
In this review of 195 studies published between January 1995 and December 2007, the overall technical success rate of endovascular treatment of supradiaphragmatic arterial injury was 96.7%, and the complication rate was 6.4%.


CONCLUSIONS
The results of this review suggest a potential morbidity and mortality benefit over traditional open repair; however, long-term data are lacking. Long-term follow-up for stent durability is of particular concern in the trauma population, which tends to comprise younger patients with minimal atherosclerotic disease. The success of endovascular techniques is also limited by the availability of skilled interventionalists, properly outfitted angiography suites, and suitable stent graft devices. Despite these challenges, the potential advantages of endovascular stenting make it a welcome addition to the armamentarium of the vascular interventionalist who treats arterial traumatic injuries.
Hershberger
Richard C
RC
Department of Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois 60153, USA. rihershberger@lumc.edu
Aulivola
Bernadette
B
Murphy
Megan
M
Luchette
Fred A
FA
D017130:Angioplasty; D001013:Aorta, Thoracic / Q000293:injuries*; D019917:Blood Vessel Prosthesis Implantation; D020212:Carotid Artery Injuries / Q000601:surgery*; D006801:Humans; D011651:Pulmonary Artery / Q000293:injuries*; D015607:Stents