Acute traumatic aortic rupture: surgical repair or endovascular stent grafting?

Objectives: Endoluminal aortic stent grafting offers a less invasive alternative to open chest surgery. We compare the results of conventional surgical repair and endovascular treatment of traumatic aortic rupture.

Methods: Retrospectively, 62 patients with acute traumatic aortic rupture were analyzed. Most patients had a rupture limited to the isthmus, and severe associated injuries; one had an ascending aorta lesion. Thirty-five patients (29 male, 6 female, mean age 38 years) underwent surgical repair. Two patients were operated on without cardiopulmonary bypass. In 27 patients (25 male, 2 female, mean age 37 years) thoracic endografts were implanted. The delay between trauma and treatment was comparable in both groups.

Results: Hospital mortality was 20% (7/35 pts.) in the surgical group and 3.7% (1/27 pts.) in the endovascular group. The main cause of death was brain-death in severely traumatized patients. Nine complications occurred in 5 surgical patients: respiratory insufficiency (n=3), pulmonary infection (n=2), recurrent nerve palsy (n=1), repeat thoracotomy (n=2) and compartment syndrome (n=1). No patient in surgical group had paraplegia. Stent-graft implantation was successful in all cases, without peri-interventional complications or paraplegia. In 9 patients the left subclavian artery was covered with the device. Two patients underwent surgical repair 15 days and 4 months, respectively, after endografting because of stent injury of the aortic wall and development of spurious aneurysm.

Conclusions: The outcome of patients with traumatic thoracic aortic rupture treated with endovascular stent grafts appears to be better than after conventional surgical repair, especially in patients with high risk for cardiopulmonary bypass.