Stent Grafts for Thoracic Aortic Pathology: Single-Center Experience in Western Australia

Endovascular stent for iatrogenic penetrating injury of the thoracic aorta

PURPOSE

This is a report of the endovascular management of an iatrogenic descending thoracic aortic injury with long-term follow-up.

CASE REPORT

A 74-year-old medically complex female underwent the inadvertent percutaneous placement of a 6F sheath directly into the descending thoracic aorta during an attempted pericardiocentesis at an outside hospital. Upon transfer, the patient underwent endovascular placement of a thoracic stent graft to cover the entry site and recovered without incidence. The patient has remained free of complications for nearly 8 years of follow-up care.

CONCLUSIONS

Endovascular stent graft utilization of the thoracic aorta has increased the treatment scope for the management of emergent and elective aortic pathology. This is particularly useful in clinical scenarios deemed too high an open surgical risk secondary to significant comorbidities.

Emergency repair of traumatic aortic rupture: Endovascular versus conventional open repair

OBJECTIVE

Our objective was to compare early results of endovascular stenting for traumatic aortic rupture with conventional open repair.

METHODS

We conducted a retrospective review of consecutive cases of traumatic aortic rupture in a single institution from July 2000 to July 2006.

RESULTS

Fifteen cases were identified. The mean injury severity score was 43 +/- 10. Fourteen patients had the procedure within 24 hours of admission to the hospital. Seven patients underwent endovascular stenting and 8 underwent open repair. For endovascular stenting, there were no failed procedures, no periprocedural complications, and no periprocedural deaths. In 6 patients, there was no evidence of endoleak, stent migration, or late pseudoaneurysm formation. One patient required a second stent 2 years later to treat a stenosis in the original stent. For open repair, cardiopulmonary bypass was used in 7 of the 8 patients. Lower limb paraplegia developed postoperatively in 1 patient and another patient died of head injuries. There was a significant reduction in the mean duration of the procedure (2.2 +/- 0.90 vs 5 +/- 3.2 hours; P = 0.04), the mean intraoperative blood loss (311 +/- 20 vs 953 +/- 20 mL; P = .02), the mean number of units of blood and blood products used (0.43 +/- 1.1 vs 3 +/- 3 units; P = .026), and the mean dose of heparin required (5000 +/- 1700 vs 24,000 +/- 7500 IU; P = .001) in the endovascular stenting group. There was no difference in duration of ventilation, intensive treatment unit, or hospital stay.

CONCLUSIONS

Endovascular stenting is technically feasible and applicable to a range of cardiac patients. It takes less time than open repair, requires less heparin and blood products, and therefore simplifies management of other injuries. In hemodynamically stable patients, endovascular stenting is the treatment of choice for traumatic aortic rupture.