Abstract
BackgroundMost blunt aortic injuries occur in the proximal proximal descending aorta causing acute transection of this vessel. Generally, surgical repair of the ruptured segment of aorta is associated with high rates of morbidity and mortality and in this view endovascular treatment seems to be a valid and safer alternative. Aim of this article is to review our experience with endovascular approach for the treatment of acute traumatic rupture of descending thoracic aorta.MethodsFrom April 2002 to November 2014, 11 patients (9 males and 2 females) were referred to our Department with a diagnosis of acute transection of thoracic aorta. Following preoperative Computed Tomography (CT) evaluation, thoracic endovascular aortic repair (TEVAR) with left subclavian artery coverage was performed. Follow-up consisted clinical and instrumental (CT, Duplex ultrasound) controls at discharge, 1, 3 and 6 months and yearly thereafter.ResultsAt 12-year follow up, the overall survival for the entire patients cohort was 100 %, no major or minor neurological complications and no episode of left arm claudication occurred. Cardiovascular, respiratory and bleeding complications, in the early period, was represented by minor, non fatal events. No stent graft failure, collapse, leak or distal migration were detected at CT scan during the entire follow up period.ConclusionsAccording to our experience, despite the small number of patient population, TEVAR procedure with with left subclavian artery coverage, performed in emergency settings, seems to provide excellent long term results.Trials registrationThe protocol was registered at a public trials registry, www.clinicaltrials.gov (trial identifier NCT02376998).
Highlights
Most blunt aortic injuries occur in the proximal proximal descending aorta causing acute transection of this vessel
Trials registration: The protocol was registered at a public trials registry, www.clinicaltrials.gov
Several studies have shown that surgical repair of an aortic rupture is associated with high rates of morbidity and mortality, in patients with multiple injuries [11, 12] and it had been delayed, because of coexisting injuries, which rendered the surgical is unacceptably high: severe head trauma, serious skeletal fractures, extensive burns, severe respiratory insufficiency, and sepsis [13,14,15,16]
Summary
Most blunt aortic injuries occur in the proximal proximal descending aorta causing acute transection of this vessel. Surgical repair of the ruptured segment of aorta is associated with high rates of morbidity and mortality and in this view endovascular treatment seems to be a valid and safer alternative. Several studies have shown that surgical repair of an aortic rupture is associated with high rates of morbidity and mortality, in patients with multiple injuries [11, 12] and it had been delayed, because of coexisting injuries, which rendered the surgical is unacceptably high: severe head trauma, serious skeletal fractures, extensive burns, severe respiratory insufficiency, and sepsis [13,14,15,16]. The result has been a decrease in both operative mortality and morbidity for patients with these conditions and it has offered a less invasive and safer alternative to open surgery in acute, high-risk surgical patients [17,18,19]
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