Endovascular treatment of traumatic rupture of thoracic aorta: long term results.

BACKGROUND: The aim of this study was to evaluate the endovascular treatment of acute post-traumatic thoracic aorta rupture. Rupture of the thoracic aorta is caused in a majority of cases by blunt trauma of the chest as a result of motor vehicle accident. Hypovolemic shock due to massive hemorrhage leads to death in almost 90% of victims. Nowadays the treatment of choice is endovascular procedure with stent-graft, which quickly seals the rupture site.

METHODS: Forty patients with post-traumatic rupture were treated in our department. In 92.5% of them, the aneurysm appeared after a road traffic accident. In all cases but one it was located below the left subclavian artery.

RESULTS: All patients underwent surgery. One-hundred per cent technical success was observed with no device failure. Six patients (15%) died in the postoperative period. All fatalities were attributable to severe generalized trauma, not to the endovascular procedure. In early postoperative follow-up we saw no serious stent-graft related complications, such as spinal cord ischemia. Nine patients (22.5%) were operated later on, due to other organs trauma. In one case (2.5%), in which the endograft was deployed below the left subclavian artery, the patient suffered from stroke, requiring conservative treatment. One early type IA endoleak was diagnosed and sealed by proximal extension. Among the patients still being followed for up to 14 years, 82% remain asymptomatic, without evidence of endoleak or stent-graft migration on angio-CT. Two type IA endoleak were found due to stent-graft infolding: one was solved with balloon-plasty, the other with a proximal extension.

CONCLUSIONS: Endovascular procedure in traumatic rupture of descending aorta is the method of choice. Endovascular procedures have a lower mortality and morbidity than open surgery.