Endovascular repair in acute traumatic disruption of the thoracic aorta.

ABSTRACT

Objective: To evaluate thoracic endovascular repair in patients with blunt traumatic thoracic aortic disruption. Methods: From February 2002 to August 2004, five multitrauma patients (4 males, 1 female) from motor vehicle accidents presented with traumatic thoracic aortic disruption. The mean age of the patients was 42 years (22-70 years). All were treated by acute endovascular repair with a covered stent graft through the femoral artery approach without administration of heparin. Results: The mean operative time was 101 minutes (75-125 minutes) with negligible intraoperative blood loss. There was no intervention related mortality and no paraplegia. In all cases the subclavian artery was over-stented intentionally, no arm ischemia was observed. One patient died after 1 week due to unrelated causes. Another patient died after 1 year from cardiomyopathy. Follow-ups of the other 3 patients (median 30 months) show good results. There was no endoleak, no stent-graft migration and no structural failure. Conclusion: Endovascular repair in acute traumatic disruption of the thoracic aorta is technically feasible, safe and with good midterm follow-up results. This procedure is an effective alternative to open surgery for multitrauma and high-risk patients.