Endovascular treatment of descending thoracic aortic rupture

Abstract

To update our experience with descending thoracic aortic rupture (DTAR) endovascular repair over a 6-year period. This was a prospective, non-randomized, single-centre study. We included all patients diagnosed with rupture of the thoracic aorta, who underwent endovascular grafting between January 2005 and January 2011. Data were analysed using SPSS version 15.0. During the study interval 25 patients were diagnosed with DTAR. Sixteen patients with ruptured degenerative aneurysm (64%), four traumatic transection (16%), three acute complicated type B dissection (12%) and two acute complicated penetrating ulcer (8%). Nineteen patients (76%) were men, six women; the mean age was 62.96 (±19.75) years. At admission, mean standard euroSCORE was 8.46 (±3.55), and mean APACHE II 14.96 (±8.53). Emergent endovascular stent grafting was successfully performed in all patients, no conversion to open repair was necessary. Mortality at Intensive Care Unit was 16% (four patients). Overall follow-up (mean 26.6 months, range 3-68) mortality in our series was 28%. Only one patient suffered a severe neurological complication (stroke). Late complications of endovascular procedure and need for reoperation appeared in one patient because of a secondary leak. Although this study is not a comparative analysis of DTAR, mortality and morbidity rates were lower than previously reported with emergent open surgical repair. One-year treatment results indicate a low incidence of graft-related complications. Endovascular treatment of the thoracic aortic rupture should be considered feasible and well tolerated in the short and medium term.