The first case report of stent-grafting for blunt extended aortic dissection

Multiple subfailures characterize blunt aortic injury

BACKGROUND

Blunt aortic injuries result from rapid deceleration of the thorax as may occur during automotive impacts and falls from extreme heights. Pathological findings can range from failure of specific vessel layers to immediate vessel wall rupture. The purpose of this investigation was to determine the sequence of local structural events that may lead to aortic wall disruption.

METHODS

Fourteen porcine aorta specimens were opened to expose the intima and longitudinally distracted until rupture. Longitudinal mechanics were quantified and subfailures were identified. Histology was used to examine internal layer subfailure.

RESULTS

Videography demonstrated that subfailures propagated into complete vessel wall rupture. Subfailures occurred before complete vessel rupture in 93% of specimens. Intimal and medial subfailures were present at 74% of the stress and 82% of the strain to rupture. Multiple subfailures were evident in 79% of specimens.

CONCLUSION

Present results supported the clinical theory that nonimmediate death as a result of blunt aortic injury is commonly caused by propagation of lesser lesions, initiating on the intimal layer, into complete vessel rupture including the adventitial layer. This finding, along with histologic evidence of subfailure pathological findings, confirms the presence of an acute window during which recognition and initiation of permissive hypotension may be lifesaving.

Emergency endovascular stent grafting of a traumatic thoracic aortic dissection

An endovascular stent graft was successfully used in the management of a patient with multiple injuries, who sustained an acute type B dissection of the thoracic aorta. We discuss the multidisciplinary approach taken, the contra-indications of conventional surgery, and the radiological imaging employed. We conclude that stent grafts can be safely deployed without morbidity or mortality in a multiply injured patient.

Blunt traumatic aortic transection: endoluminal repair with commercially available aortic cuffs

Blunt traumatic aortic transection remains a lethal condition. Treatment requires a high index of suspicion, prompt diagnosis, and expedient operative repair. Even in the best of circumstances, morbidity and mortality associated with open surgical repair are high, particularly because of frequent occurrence of other severe associated injuries. Endoluminal aortic stent-graft repair is an accepted treatment option in patients with aneurysm degeneration, and may be an alternative means of managing contained aortic transection. We describe three cases of blunt traumatic thoracic aortic transection treated with commercially available aortic endoluminal stent grafts.