Percutaneous Endovascular Repair of Blunt Thoracic Aortic Transection

Abstract

Untreated traumatic aortic transection carries a mortality rate higher than 85%. Standard therapy has been open repair via a left thoracotomy with systemic heparin and is associated with a high risk of paralysis. We reviewed our experience of endoluminal stent-graft repair for treatment of acute traumatic thoracic aortic transection. Between February 2001 and February 2005, 11 patients sustaining severe blunt trauma with multiple injuries underwent acute endovascular repair for thoracic aortic transection with 'off-the-shelf' commercially available proximal aortic cuffs. No systemic heparin was used. Access to the aorta was obtained either through a femoral/iliac cutdown (n = 4) or percutaneously through the femoral artery (n = 7). Mean follow-up was 21 months (range, 3-49 months). Technically successful repair was achieved in 100% of patients, as determined by completion angiography demonstrating apposition of the stent-grafts to the aortic wall, normal perfusion of the aortic branches, and exclusion of the aortic transection without evidence of extravasation. None of the patients required secondary interventions, and there were no instances of death or paralysis. Patient follow-up, using computed tomography angiography, demonstrated durability of endovascular repair without evidence of endoleak, stent migration, or late pseudoaneurysm formation. Adaptation and use of commercially available abdominal devices in the thoracic aorta has proven to be technically feasible. Urgent repair of thoracic aortic transection in the setting of blunt trauma can be transformed into a well-tolerated surgical intervention using endovascular techniques. Long-term durability of endovascular repair of traumatic thoracic transections remains unknown, but early and midterm results are promising.