Improved Outcomes with Endovascular Stent Grafts for Thoracic Aorta Transections

• Published in: European journal of vascular and endovascular surgery 2008-08, Vol.36 (2), p.152-157
• Main Authors: Mohan, I.V, Hitos, K, White, G.H, Harris, J.P, Stephen, M.S, May, J, Swinnen, J, Fletcher, J.P
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aneurysm, False - diagnostic imaging; Aneurysm, False - mortality; Aneurysm, False - surgery; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - injuries; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Aortic Rupture - diagnostic imaging; Aortic Rupture - mortality; Aortic Rupture - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Female; Humans; Male; Middle Aged; Multiple trauma; New South Wales - epidemiology; Retrospective Studies; Severity of Illness Index; Stent-grafts; Stents; Surgery; Thoracic aortic transection; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2008.03.012

Abstract Objective To retrospectively assess the outcome of endovascular stent-graft implantation for thoracic aortic transections (ETAT). Design Retrospective review. Methods 16 patients median age 30 years, treated between May 2000 and April 2007. Median injury severity score was 33 (range 29 to 66) in 14 acute patients; 2 patients had thoracic pseudoaneurysms. The Cook-Zenith endograft was used in eight patients, Medtronic-Talent (6) and Gore-Excluder (2). Average procedure time was 90 minutes, blood loss 100 (range 40 to 3000) mls, screening time 10.8 (range 5.9 to 22.6) minutes, and contrast dose was 195 (range 60 to 400) mls. Results Graft deployment was successful in all cases. There was one death within 30 days. The left subclavian artery was completely covered in one case, and partially in three. Two patients had Type I endoleak, and one delayed Type II endoleak. One patient had iatrogenic right coronary artery dissection. Two patients developed difficult to treat hypertension, and one acute renal failure. Conclusion Endovascular intervention is a safe and effective treatment for aortic transection in multiple trauma patients. ETAT reduces the major morbidity and mortality associated with open repair in multiple trauma patients. The majority of these patients are young and long-term follow up is necessary to assess graft durability.