ABSTRACT
INTRODUCTION: Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture. METHODS: This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture. RESULTS: Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14-66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18-36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5-96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported. CONCLUSION: TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.
Subject(s)
Aorta, Thoracic/surgery , Aortic Rupture/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Vascular System Injuries/surgery , Adolescent , Adult , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/injuries , Aorta, Thoracic/physiopathology , Aortic Rupture/diagnostic imaging , Aortic Rupture/physiopathology , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Female , Hemodynamics , Humans , Injury Severity Score , Male , Postoperative Complications/etiology , Retrospective Studies , Stents , Time Factors , Treatment Outcome , Vascular System Injuries/diagnostic imaging , Vascular System Injuries/physiopathology , Young AdultSubject(s)
Arteriovenous Fistula/etiology , Femoral Artery/injuries , Femoral Vein/injuries , Leg Ulcer/etiology , Vascular System Injuries/etiology , Wounds, Gunshot/complications , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/surgery , Blood Vessel Prosthesis Implantation , Femoral Artery/diagnostic imaging , Femoral Vein/diagnostic imaging , Humans , Leg Ulcer/diagnosis , Leg Ulcer/surgery , Male , Middle Aged , Treatment Outcome , Vascular System Injuries/diagnostic imaging , Vascular System Injuries/surgery , Wound HealingABSTRACT
Bilateral absence of the superior vena cava (SVC) is an uncommon congenital vascular anomaly, mainly asymptomatic, usually undetected, and often associated with other cardiac anomalies. Though usually harmless and totally innocent, this vascular anomaly might complicate cardiovascular surgery, the insertion of a central venous catheter and the transvenous placement of a pacemaker. This SVC anomaly is still not well known, underdiagnosed and its incidence is much higher than described. A better understanding of this anomaly and its detection could play a key role in avoiding its potential complications. We are sharing a case of a female adult, with no medical history, who presented herself to the department of visceral surgery with a collateral venous circulation of the upper thorax, that was at first, mistaken for a portal hypertension syndrome, findings were pushed to finally conclude a bilateral absence of the SVC.
