Acute traumatic aortic rupture: A comparison of surgical and stent-graft repair

Rousseau, Hervé; Dambrin, Camille; Marcheix, Bertrand; Richeux, L.; Mazerolles, Michel; Cron, C.; Watkinson, Anthony; Mugniot, Antoine; Soula, Philippe; Chabbert, V.; Canevet, G.; Roux, Daniel; Massabuau, P; Meites, G.; Van, T. Tran; Otal, Philippe

doi:10.1016/j.jtcvs.2004.12.023

Cited by 146 publications

(109 citation statements)

References 34 publications

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“…Endovascular stent grafting can be performed without aortic clamping and therefore may be applied in a larger number of patients, including hemodynamically unstable cases. The present study represents one of few high-volume singlecenter experiences in endovascular stent grafting of aortic traumatic rupture [14,19,[21][22][23][24]. The goal of the endovascular stent grafting is to provide durable exclusion of the lesion while minimizing the morbidity and mortality of the open chest procedure including thoracotomy, one-lung ventilation, cardiopulmonary bypass, significant heparinization, aortic cross-clamping, and spinal cord ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…There are only a few clinical studies reporting comparative analyses of endovascular treatment and conventional surgical repair in traumatic aortic rupture [19,[21][22][23]. In all studies, a clear trend toward improved early outcomes in favor of endovascular treatment with lower mortality, paraplegia, and postoperative complication rate is observed in comparison to open chest surgery.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Buz¹,

Zipfel²,

Mulahasanovic³

et al. 2008

European Journal of Cardio-Thoracic Surgery

106

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Objective: Endoluminal aortic stent grafting offers a potentially less invasive alternative to open chest surgery, especially in patients with polytrauma. We compare the results of conventional surgical repair and endovascular treatment of traumatic aortic rupture. Methods: Retrospectively, 74 patients with acute traumatic aortic rupture were analyzed. Most of the patients had a rupture limited to the isthmus, and severe associated injuries. Thirty-five patients (6 female, 29 male, mean age 36 years) underwent surgical repair. Two patients were operated upon without cardiopulmonary bypass. In 39 patients (5 female, 34 male, mean age 36 years) thoracic endografts were implanted. The delay between trauma and treatment was comparable in the two groups. Results: Hospital mortality was 20% (7 of 35 patients) in the surgical group and 7.7% (3 of 39 patients) in the endovascular group. The most common cause of death in the surgical group was brain death in severe traumatic patients. Ten surgical complications occurred in 5 patients: respiratory insufficiency (n = 3), pulmonary infection (n = 2), recurrent nerve palsy (n = 2), repeat thoracotomy (n = 2), and compartment syndrome (n = 1). No patient in this group had paraplegia. Except for one case, which required conversion to conventional surgery, stent-graft implantation was successful in all cases, without peri-interventional complications or procedure-induced paraplegia. In 9 patients the left subclavian artery was covered with the device. Two patients underwent surgical repair 15 days and 4 months after endografting because of injury of the aortic wall by the stent and development of a spurious aneurysm, respectively. Conclusions: In the treatment of traumatic thoracic aortic rupture, the early outcome of patients treated with endovascular stent grafts appears to be better than that with conventional surgical repair. The new technique allows safe and successful repair of this life-threatening injury in the early phase of trauma management. How far this potential benefit is sustained in the long term remains unclear at present. #

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Buz¹,

Zipfel²,

Mulahasanovic³

et al. 2008

European Journal of Cardio-Thoracic Surgery

106

View full text Add to dashboard Cite

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“…Most series report the technical success of TEVAR to be 81.1-100%, with a paraplegia rate of 0%. These series present low mortality and morbidity rates, with accompanying injuries as primary causes of morbidity and mortality (Urgnani et al, 2009, Neuhauser et al, 2004Rousseau et al, 2005). Our results revealed considerable age differences between the traumatic (blunt) aortic rupture group and the other groups.…”

Section: Discussionmentioning

confidence: 46%

Endovascular Repair of Thoracic Aortic Emergencies

Ribé¹,

Portero²,

Solis³

et al. 2011

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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“…Although rates of paraplegia are quoted in the literature as ranging from 0-5%, the majority of studies have no paraplegia, and three large meta-analyses found only 2 patients reported to have had paraplegia related or potentially related to TEVAR (Hershberger, et al, 2009;Tang, et al, 2008;Xenos, et al, 2008). In studies with direct comparison to open repair some studies have found no significant difference in morbidity, mortality or length of stay (Arthurs, et al, 2009;Lang, et al, 2010;Yamane, et al, 2008), while others have shown a significant decrease in mortality, blood loss, transfusion requirements, paraplegia rates, operating room times, and length of stay (Buz, et al, 2008;Moainie, et al, 2008;Rousseau, et al, 2005).…”

Section: Thoracic Aortamentioning

confidence: 99%