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.
Subject(s)
Angioplasty, Balloon/methods , Aorta, Thoracic/injuries , Aortic Rupture/therapy , Blood Vessel Prosthesis Implantation/methods , Stents , Wounds, Nonpenetrating/complications , Accidents, Traffic , Acute Disease , Analysis of Variance , Angiography, Digital Subtraction , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/instrumentation , Angioplasty, Balloon/mortality , Aortic Rupture/diagnosis , Aortic Rupture/etiology , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , 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 OutcomeABSTRACT
PURPOSE: The aim of this study was to evaluate the feasibility and safety of endovascular repair in acute traumatic aortic rupture on the basis of our experience with 16 patients. MATERIALS AND METHODS: From January 1996 to December 2001,16 patients, with a mean age 36 years, underwent repair of traumatic rupture of the aorta with the use of stent-grafts. All patients presented with coexisting injuries and 9 of 16 patients were hemodynamically unstable because of other injury. After a delay ranging from 9 to 245 days (mean 78 days), aortic stent-grafting was performed by a multidisciplinary team. All patients had regular follow-up with spiral CT and transesophageal echocardiogram. RESULTS: Stent-graft placement was successful in all patients with exclusion of false aneurysm. The duration of the procedure was about 120 min and mechanical respiratory assistance could be removed immediately in 80% of patients. Mean stay in the intensive care unit was 24 hours. One complication was noted: compression of the left main stem bronchus successfully treated with endoprosthesis. Maximum follow-up was 7 years. CONCLUSION: Endovascular stent-graft repair is a valuable technique and is emerging as an alternative technique for treating thoracic aortic injury in patients in whom coexisting injury increases the surgical risk.
Subject(s)
Angioplasty, Balloon , Aorta, Thoracic/injuries , Aortic Aneurysm, Thoracic/therapy , Aortic Rupture/therapy , Aortography , Blood Vessel Prosthesis Implantation , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Multiple Trauma/therapy , Stents , Tomography, Spiral Computed , Adolescent , Adult , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Rupture/diagnostic imaging , Critical Care , Female , Humans , Male , Middle Aged , Multiple Trauma/diagnostic imaging , Postoperative Complications/diagnostic imaging , Prosthesis DesignABSTRACT
PURPOSE: We assessed our experience with urological complications of laparoscopic surgery in regard to incidence, etiology, treatment and possible prevention. MATERIALS AND METHODS: A total of 350 laparoscopic procedures were performed at our institution between June 1993 and December 1999 in 206 men and 139 women. These procedures included pelvic lymph node dissection in 102, bladder neck suspension in 99, adrenalectomy in 54, varicocelectomy in 23, pyeloplasty in 22, nephrectomy in 20, treatment of benign renal pathologies, including cyst, diverticula and calculi, in 13, genitourinary prolapse repair in 11 and miscellaneous procedures in 6 patients. Complications were evaluated according to the procedure attempted and were listed by incidence and etiology. RESULTS: A total of 19 (5.4%) complications occurred in our series. The associated mortality rate was 0.3% and conversion rate was 1.1%. Most intraoperative complications (2.6%) were vascular (4) and visceral injuries (5), while postoperative complications (2.8%) were predominantly thromboembolism (3) and wound infection (2) at trocar sites. The complication rate decreased from 9% for the first 100 to 4% for the subsequent 250 procedures. CONCLUSIONS: Critical documentation of complications of laparoscopic surgery is important for further development of the technique and information for urologists in training. Most of our serious complications should be preventable with better mastery of the different procedural steps. However, laparoscopy must be regarded as major surgery with a significant learning curve.
