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Al-Adawi SSH, Naiem A, Abdelhady I, Al-Sukaiti R, Al-Hajeri M, Stephen E, Al-Shamsi S, Al-Wahaibi K. Chronic Blunt Traumatic Thoracic Aortic Injuries: Report of three cases from Oman. Sultan Qaboos Univ Med J 2021; 21:e120-e123. [PMID: 33777433 PMCID: PMC7968914 DOI: 10.18295/squmj.2021.21.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/03/2020] [Accepted: 07/05/2020] [Indexed: 11/20/2022] Open
Abstract
Blunt thoracic aortic injuries are potentially lethal. Those who survive may form an organised haematoma in the periadventitial space resulting in a pseudoaneurysm, which may be identified incidentally decades later. While the role of thoracic endovascular aortic repair (TEVAR) in acute settings has been established, its role in chronic cases is yet to be defined. We report three cases that were diagnosed incidentally six, nine and 18 years after the injury. Two were managed by TEVAR while the third declined intervention and is on annual follow-up. Patients with asymptomatic and stable pseudoaneurysms of the descending thoracic aorta should be offered surveillance versus TEVAR because the risk of rupture is not negligible, whilst taking into account the patient’s level of physical activity. These three cases highlight the importance of early diagnosis of aortic injuries in blunt trauma and its grading.
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Affiliation(s)
- Sara S H Al-Adawi
- Department of General Surgery, Oman Medical Specialty Board, Muscat, Oman
| | - Ahmed Naiem
- Department of Vascular Surgery, McGill University, Montreal, Canada
| | - Ibrahim Abdelhady
- Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rashid Al-Sukaiti
- Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Edwin Stephen
- Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Khalifa Al-Wahaibi
- Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Ajaja MR, Cheikh A, Moutaouekkil EM, Madani M, Arji M, Hassani AE, Lakhal B, Slaoui A. Endovascular treatment of acute aortic isthmian ruptures: case study. Pan Afr Med J 2017; 28:217. [PMID: 29629003 PMCID: PMC5881556 DOI: 10.11604/pamj.2017.28.217.7531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/23/2017] [Indexed: 11/29/2022] Open
Abstract
Traumatic rupture of the aortic isthmus is a rare lesion occurring in patients subjected to violent deceleration. Because of the forces involved, it is frequently associated with concomitant life-threatening injuries. The endovascular intervention has been described to be a feasible and efficient technique which may be proposed as a therapeutic option for patients with multiple traumas instead of delayed classical surgical repair after stabilization. We report the case of an adult who has had an accident with a traumatic rupture of the aortic isthmus associated with other lesions, our patient received endovascular treatment. The aortic prosthesis was imported from France and the surgery was done 3 days after the patient's admission. This procedure was performed for the first time in Morocco in our hospital with a multidisciplinary team. The prosthesis was implemented successfully and the result was very satisfactory on the heart level.
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Affiliation(s)
- Mohamed Rida Ajaja
- Department of Cardiovascular Surgery, Cheikh Zaid Hospital, Rabat, Morocco
| | - Amine Cheikh
- Abulcasis University, Faculty of Medicine, Department of Pharmacy, Cheikh Zaid Hospital, Rabat, Morocco
| | | | - Mohcine Madani
- Department of Cardiovascular Surgery, Cheikh Zaid Hospital, Rabat, Morocco
| | - Moha Arji
- Cheikh Zaid Hospital, Department of Intensive Care, Rabat, Morocco
| | - Amine El Hassani
- Mohammed V University, Faculty of Medicine and Pharmacy, Department of Pediatric, Cheikh Zaid Hospital, Rabat, Morocco
| | - Brahim Lakhal
- Mohammed V Univerity, Faculty of Medicine and Pharmacy, Department of Vascular Surgery, Rabat, Morocco
| | - Anas Slaoui
- Abulcasis University, Faculty of Health Sciences, Department of Cardiovascular Surgery, Cheikh Zaid Hospital, Rabat, Morocco
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3
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Lee CH, Huang JK, Yang TF. Experience of endovascular repair of thoracic aortic dissection after blunt trauma injury in a district general hospital. J Thorac Dis 2016; 8:1149-54. [PMID: 27293831 PMCID: PMC4886025 DOI: 10.21037/jtd.2016.04.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/27/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Traumatic thoracic aortic dissection is uncommon in clinical practice; however, it is associated with high morbidity and mortality. Thoracic aortic dissection is usually caused by sudden deceleration resulting from a traffic accident or fall. Aortic injury after blunt trauma is a critical condition. This study reported the outcomes of endovascular repair of acute traumatic aortic dissection in patients at a district general hospital. METHODS In this study, we retrospectively reviewed the clinical data of eight patients with acute traumatic aortic dissection after a blunt trauma who had undergone thoracic endovascular aortic repair (TEVAR) between January 2012 and December 2015 at a district general hospital in Taiwan. RESULTS The median age of the patients was 49±22 years (range, 20-77 years), and 6 of the 8 (75%) patients were men. Five patients were involved in traffic accidents, and 3 patients had fallen from heights. The injury severity score (ISS) of the patients ranged from 17 to 66. In all patients, the aortic injury was located near the origin of the left subclavian artery (LSA). Four patients had seal ostium of subclavian artery, left. None of the patients developed paraplegia or lower extremity ischemia. Moreover, all patients had concomitant injuries, and no patients died postoperatively. CONCLUSIONS Endovascular repair is a rapid and minimally invasive therapy for patients with traumatic aortic injury and is associated with favorable technical results.
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Attinà D, Buia F, Russo V, Pilato E, Lovato L, Bartolomeo RD, Zompatori M. Endovascular treatment of an aortic traumatic double rupture. J Cardiovasc Thorac Res 2015; 7:38-40. [PMID: 25859315 PMCID: PMC4378674 DOI: 10.15171/jcvtr.2015.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/31/2015] [Indexed: 11/09/2022] Open
Abstract
Traumatic thoracic aortic rupture is a life-threatening condition; aortic isthmus is the most common site of rupture, but in rare cases traumatic injury can localize elsewhere, such as at aortic arch or at the level of the diaphragm. In the past few years, endovascular treatment of traumatic aortic injury became a safe procedure, with lower mortality and complication, if compared with open surgery. We report a case of a 40-year-old-man admitted to emergency department after a violent car crash in which an aortic traumatic double rupture was successfully treated with two endovascular stent-grafts coverage.
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Affiliation(s)
- Domenico Attinà
- Cardio-Thoracic-Vascular Department, Cardiothoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Francesco Buia
- Cardio-Thoracic-Vascular Department, Cardiothoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Vincenzo Russo
- Cardio-Thoracic-Vascular Department, Cardiothoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Emanuele Pilato
- Cardio-Thoracic-Vascular Department, Cardiac Surgery Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Luigi Lovato
- Cardio-Thoracic-Vascular Department, Cardiothoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Roberto Di Bartolomeo
- Cardio-Thoracic-Vascular Department, Cardiac Surgery Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Maurizio Zompatori
- Cardio-Thoracic-Vascular Department, Cardiothoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
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Grabenwöger M, Alfonso F, Bachet J, Bonser R, Czerny M, Eggebrecht H, Evangelista A, Fattori R, Jakob H, Lönn L, Nienaber CA, Rocchi G, Rousseau H, Thompson M, Weigang E, Erbel R. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2012; 42:17-24. [PMID: 22561652 DOI: 10.1093/ejcts/ezs107] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Martin Grabenwöger
- Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria
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Grabenwöger M, Alfonso F, Bachet J, Bonser R, Czerny M, Eggebrecht H, Evangelista A, Fattori R, Jakob H, Lönn L, Nienaber CA, Rocchi G, Rousseau H, Thompson M, Weigang E, Erbel R. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2012; 33:1558-63. [PMID: 22561257 DOI: 10.1093/eurheartj/ehs074] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Martin Grabenwöger
- Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria
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Valente T, Rossi G, Lassandro F, Rea G, Marino M, Dialetto G, Muto R, Scaglione M. Unusual complications of endovascular repair of the thoracic aorta: MDCT findings. Radiol Med 2012; 117:831-54. [PMID: 22228128 DOI: 10.1007/s11547-011-0771-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/20/2011] [Indexed: 11/26/2022]
Abstract
With the development of minimally invasive surgical techniques, endovascular stent-graft placement has become an accepted and widely used alternative to the traditional surgical repair of aortic disease and is gaining acceptance as the treatment of choice. Many studies show that endovascular stent-graft therapy is safe and effective, although complications related to this treatment are also recognised. Although the incidence of major complication is low, neurological sequelae remain the major concern of endovascular repair. With growing experience, however, the spectrum of mid- and long-term complications has broadened to include potentially disastrous events, other than paraplegia or stroke, that require diligent surveillance. Three-dimensional data sets acquired quickly by multidetector computed tomography (MDCT) allow multiplanar reformations and 3D viewing, as well as quantitative assessment of vessel lumens, walls and surroundings. Although a large portion of radiologists will not be involved in the actual endograft deployment, many will be involved in the interpretation of postprocedural surveillance studies. Accordingly, the goal of this report is to summarise our experience with the presentation, diagnostic approach, management and outcomes of these unusual, but potentially catastrophic, postendovascular aortic repair complications to highlight their significance and increase familiarity with them among the imaging community. Increasing awareness of these complications may facilitate rapid diagnosis and/or triage and treatment.
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Affiliation(s)
- T Valente
- Dipartimento di Diagnostica per Immagini, Servizio di Radiologia, A.O.R.N. Monaldi, 80131, Napoli, Italy
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Abstract
This article outlines the clinical and radiological approach to patients with pelvic trauma. It reviews the clinical descriptions and classifications of pelvic trauma as well as the management of patients with stable and unstable fractures. A review of embolization techniques in these types of patients is provided.
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Affiliation(s)
- Scott R Broadwell
- Department of Diagnostic Radiology, University of Colorado Health Sciences Center, Denver, Colorado
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Alvarez García B, Gutiérrez Alonso V, Del Rio Sola L, Riera de Cubas L, Fernández Valenzuela V, Ros Die E, Martin Pedrosa M. Tratamiento endovascular de la aorta torácica. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Management of the Left Subclavian Artery during Endovascular Stent Grafting for Traumatic Aortic Injury – A Systematic Review. Eur J Vasc Endovasc Surg 2011; 41:758-69. [DOI: 10.1016/j.ejvs.2011.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 01/04/2011] [Indexed: 11/19/2022]
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Murad MH, Rizvi AZ, Malgor R, Carey J, Alkatib AA, Erwin PJ, Lee WA, Fairman RM. Comparative effectiveness of the treatments for thoracic aortic transaction. J Vasc Surg 2011; 53:193-199.e1-21. [DOI: 10.1016/j.jvs.2010.08.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 08/10/2010] [Accepted: 08/10/2010] [Indexed: 11/15/2022]
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Radiologic Evaluation of Blunt Thoracic Aortic Injury in Pediatric Patients. AJR Am J Roentgenol 2010; 194:1197-203. [DOI: 10.2214/ajr.09.2544] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Morgan TA, Steenburg SD, Siegel EL, Mirvis SE. Acute traumatic aortic injuries: posttherapy multidetector CT findings. Radiographics 2010; 30:851-67. [PMID: 20219840 DOI: 10.1148/rg.303105009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute traumatic aortic injury is a life-threatening entity that requires emergent treatment. Treatment was once performed with left thoracotomy, resection of the damaged aortic segment, and placement of an interposition graft. Within the past decade, endovascular therapy has gained increased acceptance, primarily because of a significant decrease in mortality and morbidity compared with those of surgery. The authors reviewed the experience with management of acute traumatic aortic injuries at their institution, as well as that reported in the literature. Complications after endovascular repair include endoleak, endograft collapse, stroke, upper extremity ischemia, paraplegia, graft infection, endograft structural failure, missed injury or stent migration, and access site complications. After surgical repair, paraplegia and ischemia to other organs, graft dehiscence, graft infection, and graft stenosis may occur. With the growing use of endovascular management of acute traumatic aortic injuries and the increased likelihood of patient survival, the radiologist will be expected to be familiar with the findings in these patients and is positioned to play a critical role in early recognition of potential complications. Early diagnosis of the complications of therapy for aortic injury is imperative for reduction of mortality and morbidity.
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Affiliation(s)
- Tara A Morgan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center and University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA
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Karmy-Jones R, Teso D, Jackson N, Ferigno L, Bloch R. Endovascular approach to acute aortic trauma. World J Radiol 2009; 1:50-62. [PMID: 21160721 PMCID: PMC2998886 DOI: 10.4329/wjr.v1.i1.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 12/18/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
Traumatic thoracic aortic injury remains a major cause of death following motor vehicle accidents. Endovascular approaches have begun to supersede open repair, offering the hope of reduced morbidity and mortality. The available endovascular technology is associated with specific anatomic considerations and complications. This paper will review the current status of endovascular management of traumatic thoracic aortic injuries.
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15
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Rizvi AZ, Murad MH, Fairman RM, Erwin PJ, Montori VM. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: A systematic review and meta-analysis. J Vasc Surg 2009; 50:1159-69. [DOI: 10.1016/j.jvs.2009.09.002] [Citation(s) in RCA: 189] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 09/01/2009] [Accepted: 09/01/2009] [Indexed: 11/26/2022]
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Endovascular grafts for treatment of traumatic injury to the aortic arch and great vessels. ACTA ACUST UNITED AC 2009; 67:660-71. [PMID: 19741416 DOI: 10.1097/ta.0b013e3181b2894c] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment of traumatic vascular injury using endovascular techniques has evolved as endovascular capabilities have advanced over the past several decades. Several endovascular techniques have been employed to address the challenges of traumatic arterial injury, including coil embolization and the use of stents, which may be either bare metal or covered with graft material. Compared with traditional surgical repair, endovascular stent grafting for the repair of traumatic arterial injury offers the advantage of decreased morbidity because a remote access site may be used, avoiding surgical dissection and lengthy operating times. METHODS A Medline (1995-2007) search was performed to find all studies discussing the use of endovascular means to treat supradiaphragmatic arterial trauma. RESULTS In this review of 195 studies published between January 1995 and December 2007, the overall technical success rate of endovascular treatment of supradiaphragmatic arterial injury was 96.7%, and the complication rate was 6.4%. CONCLUSION The results of this review suggest a potential morbidity and mortality benefit over traditional open repair; however, long-term data are lacking. Long-term follow-up for stent durability is of particular concern in the trauma population, which tends to comprise younger patients with minimal atherosclerotic disease. The success of endovascular techniques is also limited by the availability of skilled interventionalists, properly outfitted angiography suites, and suitable stent graft devices. Despite these challenges, the potential advantages of endovascular stenting make it a welcome addition to the armamentarium of the vascular interventionalist who treats arterial traumatic injuries.
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Karmy-Jones R, Jackson N, Long W, Simeone A. Current management of traumatic rupture of the descending thoracic aorta. Curr Cardiol Rev 2009; 5:187-95. [PMID: 20676277 PMCID: PMC2822141 DOI: 10.2174/157340309788970324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 01/20/2009] [Accepted: 01/21/2009] [Indexed: 11/22/2022] Open
Abstract
Traumatic rupture of the descending thoracic aorta remains a leading cause of death following major blunt trauma. Management has evolved from uniformly performing emergent open repair with clamp and sew technique to include open repair with mechanical circulatory support, medical management and most recently, endovascular repair. This latter approach appears, in the short term, to be associated with perhaps better outcome, but long term data is still accruing. While an attractive option, there are specific anatomic and physiologic factors to be considered in each individual case.
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Affiliation(s)
- Riyad Karmy-Jones
- Divisions of Thoracic-Vascular and Trauma Surgery, Southwest Washington Medical Center, Vancouver WA, USA
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18
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Geisbüsch P, Leszczynsky M, Kotelis D, Hyhlik-Dürr A, Weber TF, Böckler D. Open versus endovascular repair of acute aortic transections—a non-randomized single-center analysis. Langenbecks Arch Surg 2009; 394:1101-7. [DOI: 10.1007/s00423-009-0468-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Accepted: 01/29/2009] [Indexed: 11/30/2022]
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19
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Gavri S, Hirsch R, Di Sessa TG, Beekman III RH. Transcatheter Closure of a Peripheral Arteriovenous Fistula: A Unique Use of a Covered Stent in a Child with Complex Congenital Heart Disease. CONGENIT HEART DIS 2009. [DOI: 10.1111/j.1747-0803.2009.00271.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Fattori R, Russo V, Lovato L, Di Bartolomeo R. Optimal Management of Traumatic Aortic Injury. Eur J Vasc Endovasc Surg 2009; 37:8-14. [DOI: 10.1016/j.ejvs.2008.09.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 09/30/2008] [Indexed: 01/31/2023]
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21
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Botta L, Russo V, Savini C, Buttazzi K, Pacini D, Lovato L, La Palombara C, Parlapiano M, Di Bartolomeo R, Fattori R. Endovascular treatment for acute traumatic transection of the descending aorta: Focus on operative timing and left subclavian artery management. J Thorac Cardiovasc Surg 2008; 136:1558-63. [DOI: 10.1016/j.jtcvs.2008.07.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 04/23/2008] [Accepted: 07/26/2008] [Indexed: 10/21/2022]
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22
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Abstract
The management of thoracic vascular injury has improved dramatically over the past two decades. The availability of multi-row detector CT has facilitated early diagnosis and incorporation of minimally invasive endograft repair for traumatic aortic injury has improved mortality and paraplegia rates. This review evaluates the available data on stent-graft repair of acute blunt traumatic aortic injury and traumatic great vessel injury with regard to safety and efficacy in comparison with conventional open surgical repair.
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Affiliation(s)
- Eric K Hoffer
- Department of Radiology, Section of Vascular and Interventional Radiology, Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States.
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23
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Kische S, Akin I, Ince H, Rehders TC, Schneider H, Ortak J, Nienaber CA. Reparación mediante implantación de stents en enfermedades agudas y crónicas de la aorta torácica. Rev Esp Cardiol 2008. [DOI: 10.1157/13126047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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24
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Hoffer EK, Forauer AR, Silas AM, Gemery JM. Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review. J Vasc Interv Radiol 2008; 19:1153-64. [DOI: 10.1016/j.jvir.2008.05.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 05/10/2008] [Accepted: 05/18/2008] [Indexed: 10/21/2022] Open
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25
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Lin PH, Huynh TT, Kougias P, Wall MJ, Coselli JS, Mattox KL. Endovascular Repair of Traumatic Thoracic Aortic Injuries: A Critical Appraisal. Asian Cardiovasc Thorac Ann 2008; 16:337-45. [DOI: 10.1177/021849230801600419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blunt trauma to the thoracic aorta is life-threatening, with instant fatality in at least 75% of victims. If left untreated, nearly half of those who survive the initial injury will die within the first 24 hours. Surgical repair has been the standard treatment of blunt aortic injury, but immediate operative intervention is frequently difficult due to concomitant injuries. Although endovascular treatment of traumatic aortic disruption is less invasive than conventional repair via thoracotomy, this strategy remains controversial in young patients due to anatomical considerations and device limitations. This article reviews the likely advantages of endovascular interventions for blunt thoracic aortic injuries. Potential limitations and clinical outcomes of this minimally invasive technique are also discussed.
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Affiliation(s)
- Peter H Lin
- Division of Vascular Surgery & Endovascular Therapy
- Michael E DeBakey VA Medical Center
| | - Tam T Huynh
- Division of Vascular Surgery & Endovascular Therapy
- Michael E DeBakey VA Medical Center
| | - Panagiotis Kougias
- Division of Vascular Surgery & Endovascular Therapy
- Michael E DeBakey VA Medical Center
| | - Mathew J Wall
- Division of Cardiothoracic Surgery Michael E DeBakey Department of Surgery Baylor College of Medicine
- Ben Taub General Hospital Houston, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery Michael E DeBakey Department of Surgery Baylor College of Medicine
- Texas Heart Institute at St. Luke's Episcopal Hospital
| | - Kenneth L Mattox
- Division of Cardiothoracic Surgery Michael E DeBakey Department of Surgery Baylor College of Medicine
- Ben Taub General Hospital Houston, USA
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Methodius-Ngwodo WC, Burkett AB, Kochupura PV, Wellons ED, Fuhrman G, Rosenthal D. The Role of CT Angiography in the Diagnosis of Blunt Traumatic Thoracic Aortic Disruption and Unsuspected Carotid Artery Injury. Am Surg 2008; 74:580-5; discussion 585-6. [DOI: 10.1177/000313480807400703] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have replaced aortography and open thoracic surgery to diagnose and treat blunt traumatic thoracic aortic disruption (TTAD) in favor of CT angiography (CTA) and endovascular repair. The purpose of this study is to review our experience with the management and outcomes of TTAD and associated carotid artery injuries. In January 2003, we initiated a protocol that used CTA to evaluate all patients with suspected TTAD from blunt trauma. When TTAD was diagnosed, patients were managed by endovascular repair using abdominal aortic extension cuffs. Twenty-nine patients with TTAD were managed by endovascular repair. In all patients, abdominal endograft extension cuffs successfully excluded the traumatic disruptions. Six (21%) of these patients had concomitant, unsuspected carotid artery injury diagnosed by CTA. One patient had bilateral carotid artery dissections, sustained irreversible brain injury, and died. Four patients with common carotid dissections were successfully treated by anticoagulation and made uneventful recoveries. One patient with a common carotid–innominate artery dissection and pseudoaneurysm underwent endovascular repair. This study indicates that CTA and endovascular repair provide accurate diagnostic and therapeutic results in the management of blunt TTAD. Furthermore, CTA should include arch and cervical views to detect an unsuspected, concomitant carotid artery injury.
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Affiliation(s)
| | - Allison B. Burkett
- From the Departments of Trauma and Vascular Surgery, Atlanta Medical Center, Atlanta, Georgia
| | - Paul V. Kochupura
- From the Departments of Trauma and Vascular Surgery, Atlanta Medical Center, Atlanta, Georgia
| | - Eric D. Wellons
- From the Departments of Trauma and Vascular Surgery, Atlanta Medical Center, Atlanta, Georgia
| | - George Fuhrman
- From the Departments of Trauma and Vascular Surgery, Atlanta Medical Center, Atlanta, Georgia
| | - David Rosenthal
- From the Departments of Trauma and Vascular Surgery, Atlanta Medical Center, Atlanta, Georgia
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Tang GL, Tehrani HY, Usman A, Katariya K, Otero C, Perez E, Eskandari MK. Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: A modern meta-analysis. J Vasc Surg 2008; 47:671-5. [PMID: 17980541 DOI: 10.1016/j.jvs.2007.08.031] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 08/17/2007] [Accepted: 08/18/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Gale L Tang
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Iezzi R, Cotroneo AR, Marano R, Filippone A, Storto ML. Endovascular treatment of thoracic aortic diseases: Follow-up and complications with multi-detector computed tomography angiography. Eur J Radiol 2008; 65:365-76. [DOI: 10.1016/j.ejrad.2007.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 09/07/2007] [Accepted: 09/08/2007] [Indexed: 10/22/2022]
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Svensson LG, Kouchoukos NT, Miller DC, Bavaria JE, Coselli JS, Curi MA, Eggebrecht H, Elefteriades JA, Erbel R, Gleason TG, Lytle BW, Mitchell RS, Nienaber CA, Roselli EE, Safi HJ, Shemin RJ, Sicard GA, Sundt TM, Szeto WY, Wheatley GH. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts⁎⁎Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc. Ann Thorac Surg 2008; 85:S1-41. [PMID: 18083364 DOI: 10.1016/j.athoracsur.2007.10.099] [Citation(s) in RCA: 550] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 10/17/2007] [Accepted: 10/18/2007] [Indexed: 01/15/2023]
Affiliation(s)
- Lars G Svensson
- Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Gawenda M, Aleksic M, Reichert V, Jubel A, Gossmann A, Brunkwall J. Stent Grafts for Acute Traumatic Injury of the Thoracic Aorta: A Single-Centre Experience. Eur J Trauma Emerg Surg 2007; 33:388-94. [PMID: 26814732 DOI: 10.1007/s00068-007-7007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 06/03/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The presented study reveals the single centre experiences with the minimally invasive endovascular repair for acute traumatic thoracic aortic lesions in the care of multitrauma patients. METHODS We reviewed ten patients with acute traumatic thoracic aortic lesions treated with a thoracic aortic stent graft between April 2001 and December 2006. The prospective collected data included age, sex, injury severity score, type of endovascular graft, endovascular operation time, length of stay, length of stay in the intensive care unit, and mortality. Followup data consisted of contrast-enhanced spiral computed tomography at regular intervals. RESULTS All patients (m:f 5:5; median age, 46 years; interquartile range [IQR], 29-68.5 years) suffered severe traumatic injury, the median Injury Severity Score was 39.5 (IQR 37.3-43). All endovascular procedures were technically successful, and the median operating time for the endovascular procedure was 90 min (IQR, 65-120 min). The overall hospital mortality was 20% (n = 2), and all deaths were unrelated to the aortic rupture or stent placement. No incidence of paraplegia was present. No intervention-related mortality occurred during a median follow-up of 14.7 months (IQR, 9.7-55.8 months). CONCLUSION The endovascular approach to acute traumatic thoracic aortic lesions is feasible, safe, and effective in multitrauma patients. The low endovascular therapy-related morbidity and mortality in the postoperative period is encouraging. The results seem to be favorable to those published of open emergency repair.
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Affiliation(s)
- Michael Gawenda
- Division of Vascular Surgery, Medical Centre University of Cologne, Cologne, Germany. .,Division of Vascular Surgery, Medical Centre University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
| | - Marko Aleksic
- Division of Vascular Surgery, Medical Centre University of Cologne, Cologne, Germany
| | - Viktor Reichert
- Division of Vascular Surgery, Medical Centre University of Cologne, Cologne, Germany
| | - Axel Jubel
- Department of Trauma Surgery, Medical Centre University of Cologne, Cologne, Germany
| | - Axel Gossmann
- Institute of Radiology, Medical Centre University of Cologne, Cologne, Germany
| | - Jan Brunkwall
- Division of Vascular Surgery, Medical Centre University of Cologne, Cologne, Germany
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31
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Kische S, Rehders TC, Akin I, Ince H, Nienaber CA. Role of interventional repair in the thoracic aorta. Future Cardiol 2007; 3:399-412. [PMID: 19804231 DOI: 10.2217/14796678.3.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Endovascular treatment of chronic aneurysmatic diseases of the descending thoracic aorta has demonstrated encouraging peri-interventional mortality and morbidity and is accepted as a preferred strategy in experienced centers. The emergence of endovascular strategies for acute thoracic aortic pathologies is an even more exciting new territory for nonsurgical interventions considering the sobering results of open surgery. Although it is apparent that patients at high risk for open surgery will benefit from endovascular strategies, the exact role of stent-graft placement remains to be defined, as the community awaits solid long-term data and as devices and techniques continue to improve. While some indications and scenarios, such as acute type B dissection with associated malperfusion syndrome or imminent aortic rupture, have been shown to benefit from stent-graft treatment, others are less settled. The current paper discusses both the established and emerging indications, as well as technical and anatomical aspects of this fascinating therapeutic option.
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Affiliation(s)
- Stephan Kische
- Rostock School of Medicine, Division of Cardiology at the University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany.
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Abstract
Interventional radiologists (IRs) now play a major role in the management of thoracic aortic and great vessel trauma. The recent availability of a wide range of stent grafts able to treat vessels from 3 to 46 mm in diameter is clearly a significant contributor to this change. Stent grafts can now treat the majority of incomplete aortic injuries with much lower morbidity and mortality than open surgery. Short- to medium-term follow-up is encouraging, but the long-term durability is unknown, and close monitoring of these patients must continue. In great vessel trauma, stent grafts are a useful adjunct to balloon tamponade, embolization, and bare stents. As a result, a wide range of head neck and upper limb vascular injuries can be managed with less local trauma, blood loss, and physiological stress. The increased involvement of IR in the management of vascular trauma is not simply the result of technological advances. IRs have increasingly made themselves available to carry out these emergency procedures. IRs should assist in the development of trauma protocols and management algorithms that involve endovascular expertise early in the assessment of the major trauma patient.
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Affiliation(s)
- Simon J McPherson
- Department of Radiology, Leeds General Infirmary, Leeds, United Kingdom
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Fattori R, Russo V. Endovascular treatment of atherosclerotic and other thoracic aortic aneurysms. Semin Intervent Radiol 2007; 24:197-205. [PMID: 21326796 DOI: 10.1055/s-2007-980043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The incidence of thoracic aortic aneurysms (TAAs) is increasing with the present rate of occurrence at 10.9 cases per 100,000 people per year. The estimated 5-year risk of rupture of a TAA with a diameter between 4 and 5.9 cm is 16%, but it rises to 31% for aneurysms ≥ 6 cm. Despite increasing awareness of the importance of early diagnosis and treatment options, there are no clear guidelines available at the time of writing. Nor is there any clear evidence for specific pharmacological treatment able to resolve or delay the disease progression. Endovascular treatment (EVT), proposed as an alternative to surgery, has been considered a therapeutic innovation, especially because it is minimally invasive, which allows treatment even in high surgical risk patients. Vascular imaging is crucial for patient selection, endoprosthesis choice, and planning of the treatment because not all aneurysms are suitable. Early and midterm results are encouraging, but long-term results are necessary to definitively assess reliability of stent-graft materials and improvement in patient survival. In the choice between surgical or endovascular repair of TAAs, many factors must be considered, including the clinical situation, comorbidities, anatomy, choice of equipment, and last, but not less important, experience of the clinical team.
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Affiliation(s)
- Rossella Fattori
- Cardiothoracovascular Department, Cardiovascular Radiology Unit, University Hospital S. Orsola, Bologna, Italy
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Lettinga-van de Poll T, Schurink GWH, De Haan MW, Verbruggen JPAM, Jacobs MJ. Endovascular treatment of traumatic rupture of the thoracic aorta. Br J Surg 2007; 94:525-33. [PMID: 17443851 DOI: 10.1002/bjs.5795] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Traumatic rupture of the thoracic aorta is a life-threatening event. Open surgical repair is the ‘gold standard’, but is associated with high mortality and morbidity rates. Endovascular repair is emerging as a potentially safer alternative.
Methods
A systematic review was performed of all published literature on this subject, including the authors' own experience. Using Sumsearch, PubMed and cross-references, all published reports up to January 2006 were identified, and analysed for injuries, perioperative morbidity, mortality, operating time, hospital stay and follow-up.
Results
A total of 284 patients were identified. Reported mortality rates range from 0 to 6 per cent. The procedure-related mortality rate is about 1·5 per cent. Some 6·7 per cent of all procedures were complicated by endoleak and the overall procedure-related morbidity rate was 14·4 per cent. These results are promising compared with those of open repair, but individual experience is limited and there may be some publication bias.
Conclusion
Endovascular repair of traumatic rupture of the thoracic aorta seems to reduce morbidity and mortality in patients with multiple trauma. Ideally, both devices and experienced personnel should be available in trauma centres.
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Affiliation(s)
- T Lettinga-van de Poll
- Department of Vascular Surgery, University Hospital Maastricht, Maastricht, The Netherlands
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35
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Kurimoto Y, Morishita K, Asai Y. Endovascular stent-graft placement for vascular failure of the thoracic aorta. Vasc Health Risk Manag 2007; 2:109-16. [PMID: 17319454 PMCID: PMC1993999 DOI: 10.2147/vhrm.2006.2.2.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
It still remains undetermined whether endovascular stent-graft placement (ESGP) is the optimal initial treatment for elective cases of thoracic aortic disease because of unknown long-term results. However, it is also recognized that ESGP contributes to better outcome as an initial treatment for aortic emergency, such as rupture, aortic injury, and complicated acute type B aortic dissection. Despite the fact that most patients are elderly, early mortality rates of ESGP are reportedly around 10% in cases of ruptured degenerative thoracic aortic aneurysm. Postoperative morbidity is also superior in ESGP compared with conventional open repair. Postoperative paraplegia has rarely occurred with ESGP. In cases of blunt aortic injury (BAI), other complications may also be present because of other serious injuries. ESGP has changed the surgical strategy for BAI and partially resolved some of the clinical dilemmas. Early mortality rate is almost zero when a stent graft can be placed before re-rupture. While BAI is a very good indication for ESGP, young patients need careful management and attention because of the unknown long-term outcome. In cases of complicated acute type B aortic dissection, the two main determinants of death, shock from rupture and visceral ischemia, could be managed by ESGP with or without conventional endovascular interventions. Recent reports disclosed less than 10% early mortality with ESGP for complicated acute aortic dissection. Even if the possibility of endotension remains, ESPG seems to be beneficial for these critical patients as the preferable initial treatment. The importance of close follow-up should be stressed to avoid some devastating late complications following ESGP.
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Affiliation(s)
- Yoshihiko Kurimoto
- Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan.
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Neschis DG, Moaine S, Gutta R, Charles K, Scalea TM, Flinn WR, Griffith BP. Twenty consecutive cases of endograft repair of traumatic aortic disruption: Lessons learned. J Vasc Surg 2007; 45:487-92. [PMID: 17254737 DOI: 10.1016/j.jvs.2006.11.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Accepted: 11/15/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Endograft repair holds considerable promise in the treatment of traumatic disruption of the thoracic aorta because patients often have multiple coexisting injuries further complicating traditional open repair. In addition, patients are often young, with an aortic anatomy dissimilar to those with atherosclerotic aneurysms. As a result, techniques for endograft repair have to be refined accordingly. METHODS The records of 20 consecutive cases of traumatic aortic disruption treated by endograft repair at a single institution were reviewed. RESULTS Mean patient age was 40 years (range, 17 to 88 years), and 17 (85%) of 20 patients were men. All cases were completed. There were no procedure related deaths, but four (20%) patients died of their co-injuries. Only two (10%) of 20 required a graft >28 mm in diameter, and nine (45%) aortas were small enough to require use of 23-mm abdominal cuffs. Six (30%) of 20 cases required complete or partial coverage of the left subclavian artery. Placement of a proximal extension was required in one patient for a type I endoleak. A graft collapse occurred in one patient that required surgical removal and aortic repair. CONCLUSIONS Endovascular repair of traumatic aortic disruption can be accomplished in most cases. Compared with atherosclerotic aneurysms, the proximal thoracic aorta tends to be smaller and the arch angle tighter in an aorta 19mm in diameter. This frequently necessitates the use of smaller devices and less stiff wires. Surgeons should be prepared to cover the left subclavian artery if needed, have a wide range of device sizes in stock to avoid over-sizing, and show restraint if the anatomy appears unsuitable.
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Affiliation(s)
- David G Neschis
- Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA
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Saratzis NA, Saratzis AN, Melas N, Ginis G, Lioupis A, Lykopoulos D, Lazaridis J, Dimitrios K. Endovascular Repair of Traumatic Rupture of the Thoracic Aorta: Single-Center Experience. Cardiovasc Intervent Radiol 2007; 30:370-5. [PMID: 17295078 DOI: 10.1007/s00270-006-0186-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Traumatic rupture of the thoracic aorta secondary to blunt chest trauma is a life-threatening emergency and a common cause of death, usually following violent collisions. The objective of this retrospective report was to evaluate the efficacy of endovascular treatment of thoracic aortic disruptions with a single commercially available stent-graft. METHODS Nine men (mean age 29.5 years) were admitted to our institution between January 2003 and January 2006 due to blunt aortic trauma following violent motor vehicle collisions. Plain chest radiography, spiral computed tomography, aortography, and transesophageal echocardiography were used for diagnostic purposes in all cases. All patients were diagnosed with contained extramural thoracic aortic hematomas, secondary to aortic disruption. One patient was also diagnosed with a traumatic thoracic aortic dissection, secondary to blunt trauma. All subjects were poor surgical candidates, due to major injuries such as multiple bone fractures, abdominal hematomas, and pulmonary contusions. All repairs were performed using the EndoFit (LeMaitre Vascular) stent-graft. RESULTS Complete exclusion of the traumatic aortic disruption and pseudoaneurysm was achieved and verified at intraoperative arteriography and on CT scans, within 10 days of the repair in all patients. In 1 case the deployment of a second cuff was necessary due to a secondary endoleak. In 2 cases the left subclavian artery was occluded to achieve adequate graft fixation. No procedure-related deaths have occurred and no cardiac or peripheral vascular complications were observed within the 12 months (range 8-16 months) follow-up. CONCLUSIONS This is the first time the EndoFit graft has been utilized in the treatment of thoracic aortic disruptions secondary to chest trauma. The repair of such pathologies is technically feasible and early follow-up results are promising.
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Affiliation(s)
- Nikolaos A Saratzis
- 1st Department of Surgery, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece.
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Abstract
Endovascular repair of the traumatically injured thoracic aorta has emerged as an exceptionally promising modality that is typically quicker than open repair, with a reduced risk of paralysis. There are a specific set of anatomic criteria that need to be applied, which can be rapidly assessed by the CT angiogram. The enthusiasm for endovascular repair must be tempered by recognition of the complications and lack of long-term follow-up, particularly in younger patients. Surgeons who are skilled in open aortic repair must not only be involved, but should take on a leadership role during the planning, deployment, and follow-up of these patients. Familiarity with all of the available devices expands treatment options. As more specific devices become available, and more follow-up is accrued, the role of endovascular stents will continue to grow.
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Affiliation(s)
- Riyad Karmy-Jones
- Heart and Vascular Center, Divisions of Cardiac, Vascular and Thoracic Surgery, Southwest Washington Medical Center, SWMC Physicians Pavilion, Suite 300, 200 N.E. Mother Joseph Place, Vancouver, WA 98664, USA.
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40
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Fattori R, Russo V. Degenerative aneurysm of the descending aorta. Endovascular treatment. Multimed Man Cardiothorac Surg 2007; 2007:mmcts.2007.002824. [PMID: 24415213 DOI: 10.1510/mmcts.2007.002824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The incidence of thoracic aortic aneurysms has a rate of occurrence of 10.9 cases per 100,000 person/year, with an estimated 5-year risk of rupture ranging from 16% (diameter between 4 and 5.9 cm) to 31% (6 cm or more). Despite increasing awareness of the important role of early diagnosis in treatment options, guidelines about therapeutic strategies are actually lacking, as well as definite evidence of pharmacological treatment able to resolve or delay the disease progression. Endovascular treatment proposed as alternative to surgery has been considered a therapeutic innovation, especially because of low invasiveness, which allows to treat even high surgical risk patients. The procedure is performed under general anesthesia, mechanical ventilation and blood pressure invasive monitoring (right radial artery cannulation). The common femoral artery or external iliac artery are used for access after surgical exposure. After exposition of the artery, a 6F sheath is inserted and 5000 UI of heparin administered. Angiography is then performed to identify the lesion, landing zones and its relation to side branches. Endovascular stent-graft is thus loaded on an extra-stiff guidewire and delivered, with induced hypotension, under fluoroscopic and transesophageal echo control. Post procedural angiography and echocardiography control are performed to reveal the final result.
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Affiliation(s)
- Rossella Fattori
- Cardiothoracovascular Department, Cardiovascular Radiology Unit, University Hospital S. Orsola, Padiglione 21-Via Massarenti 9, 40138 Bologna, Italy
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41
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Steingruber IE, Czermak BV, Chemelli A, Glodny B, Bonatti J, Jaschke W, Waldenberger P, Rieger M, Neuhauser B. Placement of endovascular stent-grafts for emergency repair of acute traumatic aortic rupture: a single-centre experience. Eur Radiol 2006; 17:1727-37. [PMID: 17115167 DOI: 10.1007/s00330-006-0451-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 08/09/2006] [Accepted: 08/18/2006] [Indexed: 11/27/2022]
Abstract
The aim of this retrospective study was to evaluate mid- and long-term results of endovascular stent-graft placement for emergency repair of acute traumatic thoracic aortic rupture. From 1996 through 2005, 22 consecutive patients (mean age: 38.7 years) underwent endovascular repair of acute traumatic thoracic aortic rupture located at the aortic isthmus in most cases. All patients were at high surgical risk due to severe associated injuries. The endografts were inserted via femoral or iliac artery access under fluoroscopic guidance. Follow-up was performed postinterventionally, at 6 and 12 months and yearly thereafter, and included clinical examination and computed tomography (CT) scans. Technical and clinical success rates were 86.3%. Mean follow-up was 31.7 months. Three patients developed early type I endoleak due to the inability of the rigid graft to adapt to the curved aortic contour. In two of them conversion to open surgery was necessary. One patient had late type I endoleak and died. No other complications were observed. The outcome was successful in most patients. The mid- and long-term results of our current study are promising. However, early type I endoleak represents a problem, especially in adolescent patients with a marked curvature of the aortic arch.
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Affiliation(s)
- I E Steingruber
- Department of Radiology, University Hospital Innsbruck, Austria.
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42
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Marcheix B, Dambrin C, Bolduc JP, Arnaud C, Hollington L, Cron C, Mugniot A, Soula P, Bennaceur M, Chabbert V, Otal P, Cérène A, Rousseau H. Endovascular repair of traumatic rupture of the aortic isthmus: Midterm results. J Thorac Cardiovasc Surg 2006; 132:1037-41. [PMID: 17059920 DOI: 10.1016/j.jtcvs.2006.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 06/24/2006] [Accepted: 07/07/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The endovascular management of aortic traumatic ruptures has been proposed as an alternative to classical surgical procedures. The aim of this work was to report the midterm results of the endovascular treatment of traumatic ruptures of the isthmic aorta. METHODS Between January 1996 and July 2005, endovascular repair of blunt traumatic aortic ruptures was performed in 33 patients (mean age, 40 +/- 17 years). The stent grafts used were either Talent Medtronic (n = 27), Gore Excluder (n = 4), or Boston Vanguard (n = 2) grafts. Follow-up was 94.9% complete and averaged 32.4 +/- 28.8 months (maximum, 8 years). RESULTS Stent graft deployment was successful in all cases without need for surgical conversion. Except for one iliac rupture, which was treated with an iliofemoral bypass during the same procedure, there was no major perioperative complication. The early complications consisted of 3 primary endoleaks (1 type I and 2 type IV), 1 transient paraparesis, 1 occlusion of the main left bronchus, 1 thrombosis, and 2 pseudoaneurysms of the brachial artery. All the primary endoleaks healed within the first month. No patient died, and no aortic reinterventions were performed. The midterm complications were a mild circumferential thrombus at the distal part of the stent graft and a fracture of the nitinol stent. Both complications were asymptomatic and were discovered on systematic computed tomographic scan examination. Actuarial freedom from complication at 1 year was 96.1% +/- 3.8% and 85.5% +/- 10.6% at 3 and 5 years, respectively. CONCLUSION This study demonstrates that the endovascular treatment of blunt thoracic aortic traumatisms is a safe and effective therapeutic method without increased midterm morbidity and mortality rates.
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Affiliation(s)
- Bertrand Marcheix
- Department of Thoracic and Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France
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43
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Hoornweg LL, Dinkelman MK, Goslings JC, Reekers JA, Verhagen HJM, Verhoeven EL, Schurink GWH, Balm R. Endovascular management of traumatic ruptures of the thoracic aorta: A retrospective multicenter analysis of 28 cases in The Netherlands. J Vasc Surg 2006; 43:1096-102; discussion 1102. [PMID: 16765221 DOI: 10.1016/j.jvs.2006.01.034] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Accepted: 01/11/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Minimally invasive endovascular treatment of a traumatic rupture of the thoracic aorta is a new strategy in the care of multitrauma patients. We report the experience in The Netherlands with endovascular management of patients with acute traumatic ruptures of the thoracic aorta. METHODS We reviewed 28 patients with a traumatic thoracic aortic rupture treated with a thoracic aortic endograft between June 2000 and April 2004. All patients underwent treatment at one of the four participating level 1 trauma centers. Data collected included age, sex, injury severity score, type of endovascular graft, endovascular operation time, length of stay, length of stay in the intensive care unit, and mortality. Follow-up data consisted of computed tomographic angiography and plain chest radiographs at regular intervals. RESULTS All patients (mean age, 40.9 years; SD, 18.5 years) experienced severe traumatic injury, and the mean injury severity score was 37.1 (SD, 7.8). All endovascular procedures were technically successful, and the median operating time for the endovascular procedure was 58 minutes (interquartile range, 47-88 minutes). The overall hospital mortality was 14.3% (n = 4), and all deaths were unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during a median follow-up of 26.5 months (interquartile range, 10-34.6 months). Postoperative data showed no severe endovascular graft- or procedure-related morbidity, except for one patient with an asymptomatic collapse of the endovascular graft during regular follow-up. This was corrected by placing a second graft. CONCLUSIONS This study shows that the results of immediate endovascular repair of a traumatic aortic rupture are at least equal to those of conventional open surgical repair. Especially in these multitrauma patients with traumatic ruptures of the thoracic aorta, endovascular therapy seems to be preferable to conventional open surgical repair.
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Affiliation(s)
- Liselot L Hoornweg
- Department of Vascular Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Agostinelli A, Saccani S, Borrello B, Nicolini F, Larini P, Gherli T. Immediate endovascular treatment of blunt aortic injury: our therapeutic strategy. J Thorac Cardiovasc Surg 2006; 131:1053-7. [PMID: 16678589 DOI: 10.1016/j.jtcvs.2005.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 11/26/2005] [Accepted: 12/09/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Posttraumatic aortic rupture is a potentially lethal injury. Endovascular procedure has recently proved to be a valid option. Timing of the treatment, however, is still a debated issue. We evaluated the feasibility and safety of immediate stent-graft repair of acute posttraumatic aortic injury. METHODS From 1998 to 2005, 15 patients (11 men and 4 women, mean age 42.3 years) with blunt aortic injury were treated with immediate stent-graft positioning. In patients with clinical and radiologic signs of impending rupture, endovascular treatment was performed in an emergency setting (11 cases). In the 4 remaining patients the aortic lesion was treated after clinical management. When present, immediate life-threatening nonaortic lesions were treated before endovascular stenting (6 cases). In 1 case emergency laparotomy and endovascular procedure were performed simultaneously. Stent positioning was monitored by intraoperative transesophageal echocardiography in all cases. RESULTS Endovascular procedure was successful in 100% of the patients. Two patients died perioperatively as a consequence of a multiorgan failure. Both patients were in American Society of Anesthetists class V and were in severe intractable hemorrhagic shock before the procedure. Computed tomography scan performed before discharge showed correct positioning of the stent graft and absence of endoleaks in all cases. At a mean follow-up of 29 months (range 1-79) all patients were alive but 1, who died of unrelated cause, and no intervention-related complication had occurred. CONCLUSIONS Immediate stent-graft repair of posttraumatic aortic injury is a feasible and safe procedure. It allows us to minimize the surgical risks and to treat stable and unstable lesions even when associated lesions would contraindicate traditional surgical intervention.
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Martí M, Pinilla I, Baudraxler F, Simón MJ, Garzón G. A case of acute abdominal aortic dissection caused by blunt trauma. Emerg Radiol 2006; 12:182-5. [PMID: 16738931 DOI: 10.1007/s10140-006-0473-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 12/16/2005] [Indexed: 11/28/2022]
Abstract
We present the case of an 18-year-old man involved in a fall with blunt abdominal trauma. The patient had hypovolemic shock and findings of an acute abdomen. Initial computed tomography (CT) showed pulmonary contusion, pneumohemothorax, hemoperitoneum, hepatic contusion, right kidney laceration and vascular avulsion, rupture of the mesenteric vein, rupture of the right rectus muscle with bowel hernia, and infrarenal aortic dissection. There were no signs of limb or medullar ischemia. After hemodynamic stabilization and surgical repair of the associated lesions, the dissection was successfully treated with a self-expanding aortic Wallstent. Postprocedure CT showed a well-positioned patent stent and the patient was discharged asymptomatic. Percutaneous endovascular stent implantation is minimally invasive and seems to be a safe treatment for traumatic dissection of the abdominal aorta.
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Affiliation(s)
- Milagros Martí
- Radiology Department, Hospital Universitario La Paz, Paseo Castellana 261, Madrid 28046, Spain
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46
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Fang TD, Peterson DA, Kirilcuk NN, Dicker RA, Spain DA, Brundage SI. Endovascular management of a gunshot wound to the thoracic aorta. ACTA ACUST UNITED AC 2006; 60:204-8. [PMID: 16456457 DOI: 10.1097/01.ta.0000196318.23409.07] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tony D Fang
- Division of Trauma and Surgical Critical Care, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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Lin PH, Bush RL, Zhou W, Peden EK, Lumsden AB. Endovascular treatment of traumatic thoracic aortic injury—should this be the new standard of treatment? J Vasc Surg 2006; 43 Suppl A:22A-29A. [PMID: 16473166 DOI: 10.1016/j.jvs.2005.10.068] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 10/26/2005] [Indexed: 11/17/2022]
Affiliation(s)
- Peter H Lin
- Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
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Kieffer E, Leschi JP, Chiche L. Open repair of chronic post-traumatic aneurysms of the aortic isthmus: The value of direct aortoaortic anastomosis. J Vasc Surg 2005; 41:931-5; discussion 935. [PMID: 15944587 DOI: 10.1016/j.jvs.2005.02.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This report presents our experience with open repair of post-traumatic aneurysms of the aortic isthmus using recent surgical techniques, including distal aortic perfusion and the preferential use of direct aortoaortic anastomosis without interposition of prosthetic material. METHODS From 1990 to 2004, the senior author (EK) patients (21 men; mean age, 40.3 years) who presented with post-traumatic aneurysms of the aortic isthmus were treated operatively, either with (20 patients) or without (3 patients) distal aortic perfusion, or endovascularly with a stent graft (3 patients). In 15 (75 %) of the 20 patients treated with distal aortic perfusion, the technique consisted of resection followed by direct aortoaortic anastomosis. Eight patients, including the three patients treated with simple clamping, had prosthetic replacement. RESULTS No postoperative deaths or permanent spinal cord complications occurred. One patient required reoperation to control hemorrhage. Aortography or computed tomography angiography was performed on 12 of the 15 patients treated by direct aortoaortic anastomosis, with a mean follow-up of 58.7 +/- 8.9 months. No morphologic abnormality was found. CONCLUSION This study shows that low-risk patients with a chronic post-traumatic aneurysm of the aortic isthmus can be successfully treated with excellent long-term results by resection and direct aortoaortic anastomosis without prosthetic interposition. In our opinion, endovascular repair should only be used in patients who present with absolute contraindications for open surgical repair.
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Affiliation(s)
- Edouard Kieffer
- Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, France.
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Rousseau H, Dambrin C, Marcheix B, Richeux L, Mazerolles M, Cron C, Watkinson A, Mugniot A, Soula P, Chabbert V, Canevet G, Roux D, Massabuau P, Meites G, Tran Van T, Otal P. Acute traumatic aortic rupture: A comparison of surgical and stent-graft repair. J Thorac Cardiovasc Surg 2005; 129:1050-5. [PMID: 15867779 DOI: 10.1016/j.jtcvs.2004.12.023] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The study's objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture. METHODS A total of 76 patients (14-76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5-257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up. RESULTS In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13-90 months). No major complication was observed in group 3. CONCLUSIONS In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.
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MESH Headings
- Accidents, Traffic
- Acute Disease
- Analysis of Variance
- Angiography, Digital Subtraction
- Angioplasty, Balloon/adverse effects
- Angioplasty, Balloon/instrumentation
- Angioplasty, Balloon/methods
- Angioplasty, Balloon/mortality
- Aorta, Thoracic/injuries
- Aortic Rupture/diagnosis
- Aortic Rupture/etiology
- Aortic Rupture/therapy
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Blood Vessel Prosthesis Implantation/methods
- Blood Vessel Prosthesis Implantation/mortality
- Echocardiography, Transesophageal
- Female
- Follow-Up Studies
- Humans
- Injury Severity Score
- Male
- Patient Selection
- Retrospective Studies
- Stents/adverse effects
- Thoracotomy/adverse effects
- Thoracotomy/instrumentation
- Thoracotomy/methods
- Thoracotomy/mortality
- Time Factors
- Tomography, Spiral Computed
- Treatment Outcome
- Wounds, Nonpenetrating/complications
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Affiliation(s)
- H Rousseau
- Department of Radiology, University Hospital Rangueil, 01 av. J Poulhes, 31403 Toulouse, France.
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Pacini D, Angeli E, Fattori R, Lovato L, Rocchi G, Di Marco L, Bergonzini M, Grillone G, Di Bartolomeo R. Traumatic rupture of the thoracic aorta: Ten years of delayed management. J Thorac Cardiovasc Surg 2005; 129:880-4. [PMID: 15821658 DOI: 10.1016/j.jtcvs.2004.10.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Traumatic rupture of the thoracic aorta is a highly fatal condition in which patient outcome is strongly conditioned by other associated injuries. Delayed aortic treatment has been proposed to improve results. METHODS The charts of 69 patients with traumatic rupture of the thoracic aorta observed between 1980 and 2003 were reviewed. Patients were grouped according the timing of repair: group I, immediate repair (21 patients); and group II, delayed repair (48 patients). In group II, 45 patients were treated surgically or by endovascular procedure. RESULTS In-hospital mortalities were 4 of 21 patients (19%) in group I and 2 of 48 patients (4.2%) in group II. There were 3 cases of paraplegia in group I and none in group II. CONCLUSION Improvement of patient outcome with traumatic rupture of the thoracic aorta can be achieved by delaying surgical repair until after management of major associated injuries if there are no signs of impending rupture. Endovascular treatment is feasible and safe and may represent a valid alternative to open surgery in selected cases.
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Affiliation(s)
- Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy.
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