Endovascular treatment of traumatic thoracic aortic injuries

Robert J Feezor, Philip J Hess, Tomas D Martin, Charles T Klodell, Thomas M Beaver, Lawrence Lottenberg, Larry C Martin, W Anthony Lee
Journal of the American College of Surgeons 2009, 208 (4): 510-6

BACKGROUND: Although a large proportion of patients with traumatic thoracic aortic injury die before undergoing definitive repair, those who survive still face ongoing risk of death and morbidity. Endovascular therapy may offer a minimally invasive alternative in the repair of the aortic injury.

STUDY DESIGN: We reviewed our experience with endovascular repair of traumatic aortic injuries using medical records, imaging studies, and a prospectively maintained endovascular and institutional trauma database.

RESULTS: Twenty-two patients underwent thoracic endovascular repair (TEVAR) of traumatic aortic injuries over 44 months. The mean (SD) age was 34+/-12 years and 68% were men. Among the 16 patients registered with our trauma database, the mean Injury Severity Score was 33+/-16 (range, 13 to 45). All injuries were sustained from blunt trauma; 95% of patients had nonaortic thoracic injuries, and 64% and 55% had extremity and abdominal injuries, respectively. Intraoperatively, 91% were repaired under general anesthesia, the mean procedure time was 80+/-52 minutes, and mean blood loss was 219+/-72 mL. The mean fluoroscopy time was 13+/-5 minutes and contrast volume 98+/-23 mL. Twenty-one patients (95%) required coverage of the left subclavian artery to achieve an adequate proximal landing zone. There were no in-hospital or 30-day deaths. The median length of stay was 8 days (range, 1 to 62 days), and 11 (50%) patients were able to be discharged home (versus to another extended care facility). At a mean followup of 7.7 months (range, 0 to 40 months) there were 2 patients (9%) who required endograft-related reintervention at 1 and 6 months. One was an access-related complication, and the second was complete device collapse with acute aortic occlusion, resulting in the patient's death.

CONCLUSIONS: Although patients who undergo endovascular repair of traumatic thoracic aortic transections typically have significant concomitant injuries, the procedure itself is well tolerated and can be performed rapidly with minimal blood loss and contrast administration. But close followup is necessary given the risk of late complications.

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