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Endovascular repair of blunt traumatic thoracic aortic injuries: seven-year single-center experience

Manuel Garcia-Toca, Peter A Naughton, Jon S Matsumura, Mark D Morasch, Melina R Kibbe, Heron E Rodriguez, William H Pearce, Mark K Eskandari
Archives of Surgery 2010, 145 (7): 679-83
20644131

HYPOTHESIS: Thoracic endovascular aortic repair (TEVAR) for acute blunt thoracic aortic injury has good early and mid-term results.

DESIGN: Single-center retrospective 7-year review from January 2001 to December 2008.

SETTING: Urban tertiary care hospital.

PATIENTS: Twenty-four consecutive patients with acute blunt thoracic aortic injury treated with TEVAR.

MAIN OUTCOME MEASURES: Procedure-related mortality, stroke, or paraplegia; injury severity score; and complications.

RESULTS: Among the 24 treated patients (mean age, 41 years; range, 20-71 years), the mean injury severity score was 43 (range, 25-66). Thoracic endovascular aortic repair was successful in treating the aortic injury in all patients and there were no instances of procedure-related death, stroke, or paraplegia. Access to the aorta was obtained through an open femoral/iliac approach (n = 7) or an entirely percutaneous groin approach (n = 17). Systemic heparin was not used in 84% of cases. Two access complications (8%) occurred, requiring an iliofemoral bypass in one patient and a thrombectomy in another. One patient required secondary intervention for device collapse, which was treated successfully with repeat endografting. There have been no delayed device failures or complications among the entire cohort at mid-term follow-up.

CONCLUSION: Thoracic endovascular aortic repair, via a percutaneous groin approach and without systemic anticoagulation, for blunt thoracic aortic injury can be performed safely with low periprocedural mortality and morbidity.

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