The role of echocardiography in the early diagnosis of the complications of endovascular repair of blunt aortic injury.
OBJECTIVE
Endovascular repair of traumatic aortic injury has been associated with severe procedural complications, including endoleaks, coverage of the left subclavian artery, stent collapse, access complications, and questionable durability. Echocardiography has proven to be a valuable tool in the intraoperative detection of these complications. In the current study, we report on the use of echocardiography as an early postoperative diagnostic technique for the evaluation of endovascular stent graft positioning in the intensive care setting.


METHODS
From January 2005 to January 2009, 14 patients who underwent endovascular repair of a blunt aortic injury were admitted in our intensive care unit. Transesophageal and/or transthoracic echocardiography were used as first-line diagnostic tools in the assessment of the endovascular graft position.


RESULTS
Twenty-eight percent of patients (4 of 14) developed a pressure gradient between upper and lower limbs (greater than 50 mm Hg), which presented with persistent hypertension, requiring antihypertensive therapy in high doses and difficult weaning. In all 4 patients, stent graft malposition was identified using echocardiography. The diagnosis was verified by computed tomography and aortography.


CONCLUSIONS
Noninvasive echocardiographic monitoring proved to be a valuable tool in the early diagnosis of postoperative stent graft malalignment. To our knowledge, this is the first time that echocardiography is described in the relevant literature as an early diagnostic technique in this setting.
Intensive Care Unit, Papageorgiou General Hospital, Thessaloniki, Greece. victoria.metaxa@nhs.net
Victoria
V
Metaxa
Matthew
M
Tsagourias
Dimitrios
D
Matamis
D000328:Adult; D000704:Analysis of Variance; D001011:Aorta / Q000293:injuries* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D042241:Early Diagnosis; D004452:Echocardiography; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012307:Risk Factors; D015607:Stents; D014949:Wounds, Nonpenetrating / Q000601:surgery*