Immediate endovascular repair for acute traumatic injuries of the thoracic aorta: a multicenter analysis of 28 cases

Jean-Marc Alsac, Benoit Boura, Pascal Desgranges, Jean-Noël Fabiani, Jean-Pierre Becquemin, Guy Leseche et al.
Journal of Vascular Surgery 2008, 48 (6): 1369-74

OBJECTIVE: Endovascular repair of injured thoracic aorta offers a new minimal invasive therapeutic option that could be beneficial in the urgent management of polytrauma patients. The aim of this study was to assess our multicenter experience of immediate endovascular repair for acute traumatic injuries of the thoracic aorta.

METHODS: Between April 2002 and October 2007, all patients treated for an acute traumatic injury of the thoracic aorta, in a less than 12-hour delay, by endovascular repair, were reviewed retrospectively in three Parisian trauma centers. Collected data included age, sex, associated comorbidities, and traumatic lesions to determine the Traumatic Injury Severity Score (TRISS), the type of aortic lesion assessed by computed tomography (CT)-scan and transesophageal ultrasonography, technical aspects of endovascular repair, length of hospital stay, and postoperative mortality. Patients were regularly followed by clinical examination, chest radiographs, and thoracic CT-scan.

RESULTS: Twenty-eight patients (20 males, mean age 45 +/- 18.8 years) were treated in a median delay of 5 hours (range 2 to 10 hours) after initial trauma. They all experienced severe traumatic injuries with a mean predictive mortality of 55.6% +/- 33.1% according to TRISS. Aortic lesions were associated with aortic parietal hematoma (71%), hemomediastinum (86%), and hemothorax (68%). All endovascular procedures were technically successful through femoral (n = 24) or iliac access (n = 4), in a mean operating time of 94 +/- 35.8 minutes. Proximal sealing of the endografts required the coverage of the origin of the left subclavian artery in 13 cases and of the left common carotid in one case. The median of hospital stay was 27 days (range 9 to 127 days), with an overall hospital mortality of 17.9% (n = 5). All deaths were unrelated to the aortic rupture or the stent placement, and no intervention-related morbidity or mortality was recorded during a median follow-up of 24 months (range 5 to 73 months).

CONCLUSION: Endovascular stent grafting allows an immediate efficient repair for acute traumatic injuries of the thoracic aorta. This early management is, however, associated with a high in-hospital mortality, related to the severe concomitant injuries of such unselected multitrauma patients.

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