Endovascular Management of Traumatic Thoracic Aorta Injury

Background: Acute traumatic rupture of the descending thoracic aorta is a life-threatening situation. Endovascular technique offers a minimal invasive alternative compared to open surgical repair, thereby reducing morbidity and mortality. The aim of this study is to evaluate the early outcomes of patients undergoing thoracic endovascular aortic repair for blunt aortic isthmus injury. Method(s): Between January 2009 and October 2018, 52 patients with acute traumatic rupture of the descending thoracic aorta were treated with a stent-graft. Preoperative workup included body computed tomography scan for all patients. The endovascular management was selected because of associated polytrauma. The injuries were classified into categories (grades I-IV) based on severity: intimal tear, intramural hematoma, pseudo aneurysm, or rupture. Result(s): Ninety-two percent (23/2) of patients were male with mean age of 38.4 (range 16-78) years. Thoracic stent grafts were implanted within a median of 5 days following injury (range 01-15 days). Seventy-two percent of aortic injuries were grade III. Mean injury severity score was 29 (range 16-61). The left subclavian artery was completely covered in70% of patients. One patients underwent staged procedure: left carotid artery and subclavian artery revascularization then endograft procedure; due to a retrograde dissection involving the origin of the left carotid artery. The median procedure time was 50 minutes, and median hospital stay was 8.9 days. There was 100% successful device delivery and deployment. The postoperative course was uneventful, especially no upper limb ischemia or neurologic complication. No procedure-related deaths have occurred and no cardiac or peripheral vascular complications were observed within the 12 months (range 6-16 months) follow-up. Computed tomography at one month showed in one patient a complete coverage of the left carotid artery by the stent graft without any clinical consequence, and in one patient endoleak type 3. Conclusion(s): Thoracic endovascular aortic repair in treatment of blunt thoracic aortic injuries showed a good early outcome. It is considered the new gold standard treatment. Dealing with young patient represents the big challenge.

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Artikel online veröffentlicht:
11. Mai 2021