title: Impact of stent-graft development on outcome of endovascular repair of acute traumatic transection of the thoracic aorta.
abstract: OBJECTIVE
  To analyze the impact of stent-graft design on the outcome of endovascular repair of acute traumatic thoracic aortic transection.
  
  
  METHODS
  Forty-eight patients (38 men; mean age 37 ± 11 years) underwent endovascular repair for an acute traumatic aortic rupture between April 2001 and March 2011. Up to October 2007, 32 patients (mean age 41 ± 16 years; group 1) were treated with the first generation of commercially available thoracic stent-grafts (10 Talent, 20 Excluder/TAG, 2 Zenith). From November 2007, 16 patients (mean age 42 ± 19 years; group 2) were treated with second-generation thoracic stent-grafts (13 Valiant and 3 C-TAG). The 2 groups were statistically comparable. Follow-up computed tomography was performed at 1 week; at 3 and 6 months; and annually thereafter.
  
  
  RESULTS
  In the 2 groups, the mortality rate related to aortic repair was nil. All the patients have completed each of their scheduled follow-up evaluations and CT scans. The morbidity rate was significantly reduced (p = 0.0003) from 18.7% (first generation) to 6.2% (second generation). Type I endoleak (n = 1), inadvertent coverage of the supra-aortic trunks (n = 3), and stent-graft collapse (n = 2) occurred only with the first-generation stent-grafts. One iliac artery rupture occurred with a second-generation stent-graft.
  
  
  CONCLUSIONS
  Enhanced stent-graft conformability and more accurate delivery systems have significantly decreased the morbidity of endovascular repair of acute traumatic transection of the thoracic aorta. The increasing clinical experience may also have contributed to improved results.
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France. ludoviccanaud@hotmail.com
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.forename: Frédéric
authors.initials: F
authors.lastname: Joyeux
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Berthet
authors.forename: Kheira
authors.initials: K
authors.lastname: Hireche
authors.forename: Charles
authors.initials: C
authors.lastname: Marty-Ané
authors.forename: Pierre
authors.initials: P
authors.lastname: Alric
mesh_terms: D000208:Acute Disease; D000328:Adult; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013895:Thoracic Arteries / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D055815:Young Adult