title: Hemothorax Management After Endovascular Treatment For Thoracic Aortic Rupture.
abstract: OBJECTIVE
  The aim was to describe and analyze the management of hemothorax (HTX) and the occurrence of respiratory complications after endovascular repair of thoracic aortic rupture (TEVAR).
  
  
  METHODS
  This was a multicenter study with retrospective analysis. Between November 2000 and December 2012, all patients with confirmed HTX due to rupture of the descending thoracic aorta treated with TEVAR were included. Respiratory function (acid base status, Pao2, Paco2, lactate, and respiratory index) was monitored throughout hospitalization. Primary endpoints were survival and post-operative respiratory complications.
  
  
  RESULTS
  Fifty-six patients were treated. The mean age was 62 ± 21 years (range 18-92 years). Etiology included traumatic rupture (n = 23, 41%), atherosclerotic aneurysm (n = 20, 36%), Debakey type IIIa dissection (n = 8, 14%), and penetrating aortic ulcer (n = 5, 9%). The primary technical success of TEVAR was 100%. The in hospital mortality rate was 12.5% (n = 7). Hemothorax was drained in 21 (37.5%) cases. In hospital respiratory complications occurred in 23 (41%) patients who required a longer intensive care unit stay (days 2.3 ± 0.7 vs. 1.9 ± 0.8, p = .017), and hospitalization (26 ± 17 vs. 19 ± 17, p = .021). Those who developed post-operative respiratory complications had lower pre-operative PO2 values (mmHg, 80 ± 24 vs. 91 ± 21, p = .012). Respiratory complications and in hospital mortality did not differ among aortic pathologies (p = .269 and p = 1.0, respectively), nor did in hospital mortality differ between patients with and without respiratory complications (13% vs. 12%; p = .990).
  
  
  CONCLUSIONS
  Thoracic aortic rupture still has a high mortality rate. Respiratory complications have not been eliminated by endovascular repair. HTX evacuation may have had a positive influence on the survival in these patients. Although traumatic and degenerative ruptures are two significantly different scenarios, survival and respiratory outcomes were similar and were not affected by the underlying aortic disease.
authors.affiliation: Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Hospital, Varese, Italy. Electronic address: gabriele.piffaretti@uninsubria.it.
authors.forename: G
authors.initials: G
authors.lastname: Piffaretti
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua University Hospital, Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Menegolo
authors.affiliation: Department of Vascular Surgery, "Vita Salute" University School of Medicine, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Kahlberg
authors.affiliation: Cardiac Surgery, Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Department of Vascular Surgery, "Vita Salute" University School of Medicine, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Rinaldi
authors.affiliation: Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Hospital, Varese, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Castelli
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua University Hospital, Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Grego
authors.affiliation: Department of Vascular Surgery, "Vita Salute" University School of Medicine, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Chiesa
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua University Hospital, Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Antonello
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006491:Hemothorax / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies
keywords: Hemothorax; Respiratory complications; TEVAR; Thoracic aortic endovascular repair; Thoracic aortic rupture