Blunt traumatic aortic transection: the endovascular experience

Orford, V. P. C.; Atkinson, Noel; Thomson, Ken; Milne, P. Y.; Campbell, William A.; Roberts, Andrew; Goldblatt, John; Tatoulis, James

doi:10.1016/s0003-4975(02)04331-x

Cited by 92 publications

(54 citation statements)

References 12 publications

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“…Both Semba et al 13 and Kato et al 14 have reported endovascular stent -graft treatment of acute traumatic rupture with low mortality and no neurologic complications. The good operative results in the present and other series 15,16 attest to the worth of considering this treatment as the first choice for BAI with severe associated complications.…”

Section: Discussionsupporting

confidence: 70%

Endovascular Stent-Graft Treatment for Blunt Aortic Injury

Kato

Sato

et al. 2004

Circ J

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lunt aortic injury (BAI) is a life-threatening complication of chest trauma. Approximately 85% of patients die at the scene of the accident 1 and patients who arrive at hospital alive frequently have associated lesions such as cerebrospinal trauma, abdominal trauma, or multiple bone fractures. The standard surgical technique for BAI requires left posterolateral thoracotomy, singlelung ventilation, proximal aortic cross-clamping, and use of cardiopulmonary bypass (CPB) or left atriofemoral shunt for preventing ischemic, neurologic, and visceral complications during the cross-clamping. Despite the recent advances in surgical and circulatory assistance techniques, postoperative mortality ranges from 15% to 30%. [1][2][3][4] The presence of severe associated injuries precludes the massive systemic heparinization required for circulatory assistance and thus makes conventional surgery very risky. Several reports have recently demonstrated the safety and efficacy of endoluminal grafting in thoracic aortic diseases 5-10 and we report here on the emergency or semiemergency repair of 6 cases of BAI successfully treated with an endoluminal stent -graft. Methods Patient SelectionFrom January 2002 to October 2003, 6 patients were admitted with a BAI. Two patients had been in automobile accidents, 1 in a motorcycle accident, and 3 had fallen (Table 1). Three of the patients were male and the age range was 18-57 years (mean, 34.5 years).In 5 patients the BAI was diagnosed by computed tomo- Circulation Journal Vol.68, June 2004graphy (CT) in the emergency room after clinical suspicion was raised by symptoms and/or chest radiograph findings. One patient was treated as a BAI 7 days after the accident because of delayed diagnosis of a periaortic hematoma. The indication for the stent -graft procedure was the presence of serious comorbidities, such as severe pulmonary contusions, closed head injury, spinal cord injury, and pelvic fracture, that made open surgical repair extremely risky (Table 1). Preoperative workup included spiral CT scan of the chest, transesophageal echography (TEE), and subtraction angiography of the thoracic aorta. During the same period as this series, we performed 4 open repairs for BAI (age range, 17-67) because those patients were considered a low risk for open surgery, having either few associated injuries (3 patients) or a long interval (8 years) after the original trauma (1 patient). Stent -GraftThe dimensions of the stent -graft were determined from the CT and angiography images (Fig 1a-c). The precise diameters proximal and distal to the injured aorta were measured using the CT built-in scale of straight line distance for CT (Hispeed Advantage SG: GE Medical Systems, Milwaukee, WI, USA). We confirmed these diameters using intraoperative angiography with a measuring guidewire. The graft was oversized by 10% compared with the normal, adjacent aorta and in this series, the average stent -graft diameter was 23 mm (range, 18-26 mm), and average length was 92 mm (range, 58-110 mm).The homemade stent -graft ...

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Section: Discussionsupporting

confidence: 70%

Endovascular Stent-Graft Treatment for Blunt Aortic Injury

Kato

Sato

et al. 2004

Circ J

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“…This patient developed no clinical sequelae due to coverage of the left subclavian artery. In similar reports, other authors have demonstrated the safety of this deliberate left subclavian coverage, whereby further endoluminal intervention or carotid to subclavian bypass can be performed if symptoms of limb ischemia or vertebrobasilar insufficiency should develop [10,11,18].…”

Section: Discussionmentioning

confidence: 67%

“…Overall, this represents early postoperative complication rate of 37.5%, which is significant. Brachial thrombosis is an unfortunate complication of percutaneous arterial access, and is probably related to the ratio of arterial diameter and the sheath diameter [4,11,17]. An alternative may be cut down access to the brachial artery, however, this may increase overall operative time in a critically ill patient population and may unnecessarily complicate the procedure in the majority of patients.…”

Section: Discussionmentioning

confidence: 99%

The Midterm Results of Stent Graft Treatment of Thoracic Aortic Injuries

McPhee¹,

Asham²,

Rohrer³

et al. 2007

Journal of Surgical Research

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“…Additionally, the terms acute and chronic traumatic lesion is used incongruent in literature [6,13,18]. Nevertheless, the concomitant injuries seem to be the cause of mortality in patients treated with an endovascular stent graft [19][20][21][22]. Even in our cohort, the two cases of mortality were related to the contusion of the heart arising incurable arrhythmia.…”

Section: Discussionmentioning

confidence: 81%