title: Endovascular treatment of traumatic rupture of thoracic aorta: long term results.
abstract: BACKGROUND
  The aim of this study was to evaluate the endovascular treatment of acute post-traumatic thoracic aorta rupture. Rupture of the thoracic aorta is caused in a majority of cases by blunt trauma of the chest as a result of motor vehicle accident. Hypovolemic shock due to massive hemorrhage leads to death in almost 90% of victims. Nowadays the treatment of choice is endovascular procedure with stent-graft, which quickly seals the rupture site.
  
  
  METHODS
  Forty patients with post-traumatic rupture were treated in our department. In 92.5% of them, the aneurysm appeared after a road traffic accident. In all cases but one it was located below the left subclavian artery.
  
  
  RESULTS
  All patients underwent surgery. One-hundred per cent technical success was observed with no device failure. Six patients (15%) died in the postoperative period. All fatalities were attributable to severe generalized trauma, not to the endovascular procedure. In early postoperative follow-up we saw no serious stent-graft related complications, such as spinal cord ischemia. Nine patients (22.5%) were operated later on, due to other organs trauma. In one case (2.5%), in which the endograft was deployed below the left subclavian artery, the patient suffered from stroke, requiring conservative treatment. One early type IA endoleak was diagnosed and sealed by proximal extension. Among the patients still being followed for up to 14 years, 82% remain asymptomatic, without evidence of endoleak or stent-graft migration on angio-CT. Two type IA endoleak were found due to stent-graft infolding: one was solved with balloon-plasty, the other with a proximal extension.
  
  
  CONCLUSIONS
  Endovascular procedure in traumatic rupture of descending aorta is the method of choice. Endovascular procedures have a lower mortality and morbidity than open surgery.
authors.affiliation: Department of General and Thoracic Surgery, Warsaw Medical University, Warsaw, Poland - gogutek@me.com.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Szostek
authors.forename: Wawrzyniec
authors.initials: W
authors.lastname: Jakuczun
authors.forename: Marcin
authors.initials: M
authors.lastname: Oseka
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Szostek
authors.forename: Abdul
authors.initials: A
authors.lastname: Alagbari
authors.forename: Ryszard
authors.initials: R
authors.lastname: Pogorzelski
authors.forename: Mieczystaw
authors.initials: M
authors.lastname: Szostek
authors.forename: Maciej
authors.initials: M
authors.lastname: Skorski
authors.forename: Agata
authors.initials: A
authors.lastname: Kocka
authors.forename: Mariusz
authors.initials: M
authors.lastname: Piotrowski
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057867:Endoleak / Q000453:epidemiology; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D011183:Postoperative Complications / Q000453:epidemiology; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery; D055815:Young Adult