Lessons learned from midterm follow-up of endovascular repair for traumatic rupture of the aortic isthmus

• Published in: Journal of vascular surgery 2008-04, Vol.47 (4), p.733-738
• Main Authors: Canaud, Ludovic, MD, Alric, Pierre, MD, PhD, Branchereau, Pascal, MD, Marty-Ané, Charles, MD, PhD, Berthet, Jean-Philippe, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aorta, Thoracic - injuries; Aorta, Thoracic - surgery; Aortic Rupture - diagnostic imaging; Aortic Rupture - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Cardiology. Vascular system; Diseases of the aorta; Female; Follow-Up Studies; Humans; Intraoperative Complications; Male; Medical sciences; Middle Aged; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - methods
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2007.12.008

Objective The aim of this study was to evaluate the short- and midterm results following endovascular repair of a traumatic rupture of the aortic isthmus. Methods Between January 2001 and January 2007, 27 patients underwent endovascular repair for acute traumatic rupture of the aortic isthmus (8 women, 19 men, mean age 40.2 ± 16.7 years [19-78]). All patients underwent a computed tomography scan resulting in the preoperative diagnosis of aortic disruptions. Twenty-one patients were treated within the first 5 days following diagnosis. Follow-up computed tomography scans were performed at 1 week, at 3 and 6 months, and annually thereafter. The median follow-up was 40 months. Results All endografts were successfully deployed (Excluder-TAG [16], Talent [10], Zenith [2]). Three patients required common iliac artery access. The morbidity rate was 14.8%: two cases of inadvertent coverage of supra-aortic trunks occurred peroperatively, a proximal type I endoleak was successfully treated by a proximal implantation of a second endograft, and one collapse of an endograft was successfully treated by open repair and explantation. No patient suffered transient or permanent paraplegia, cerebral complication, endograft migration, or secondary endoleak. The overall mortality rate was 3.7%. Conclusions Short and midterm results following endovascular treatment for traumatic rupture of the aortic isthmus favor the proposition of endovascular repair as the first-line treatment in hemodynamically unstable patients. In hemodynamically stable patients, the preoperative morphological evaluations aim to assess aortic anatomy and thereby detect possible technical limitations (aortic diameter