Endovascular repair for acute traumatic transection of the descending thoracic aorta: experience of a single centre with a 12-years follow up

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).

Blunt thoracic aortic injury – concepts and management

“…Left upper extremity ischemia, vertebrobasilar insufficiency and coronary steal are also rare complications that occur. Most patients with blunt thoracic aortic injury are young otherwise healthy patients that tolerate LSCA coverage with no issues [57,58]. For instance, the RESCUE trial presented 52 patients who underwent TEVAR BTAI; 20 required complete LSCA coverage and 9 required partial LSCA coverage.…”

Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

“…Especially rapid endovascular repair for bleeding control has evolved as primary option for certain clinical entities of vascular injury, like embolization in pelvic bleeding, stentgraft implantation in aortic transection or thoracic outlet vessel breach [22, 25, 31, 32]. However, mangled extremities remain a domain of open vascular repair (Fig.…”

Thoracic Endovascular Repair for Acute Traumatic Transection of the Descending Thoracic Aorta and Postendovascular Remodeling Change

“…2 Computed tomography (CT) enables the rapid screening and diagnosis of TTA, and technical improvements have allowed the visualization of the various features of TTA, thus aiding in treatment decision making. [2][3][4][5][6][7] Surgical treatment is absolutely recommended for grade IV lesions (rupture), according to the guidelines issued by the Society for Vascular Surgery, although there is some controversy about grade III aortic pseudoaneurysms. 4,[6][7][8] Traditional surgical treatment involves replacing the aortic lesion with an artificial graft under cardiopulmonary bypass; however, this method has been reported to result in operative mortality and paraplegia rates of 20% to 30% and 9%, respectively.…”

“…[2][3][4][5][6][7] Surgical treatment is absolutely recommended for grade IV lesions (rupture), according to the guidelines issued by the Society for Vascular Surgery, although there is some controversy about grade III aortic pseudoaneurysms. 4,[6][7][8] Traditional surgical treatment involves replacing the aortic lesion with an artificial graft under cardiopulmonary bypass; however, this method has been reported to result in operative mortality and paraplegia rates of 20% to 30% and 9%, respectively. 3 TEVAR offers several obvious benefits over traditional surgery, because most patients diagnosed as having TTA have serious comorbid injuries and heparin use during cardiopulmonary bypass could promote bleeding.…”

“…In addition, because the aortic flow is not blocked, TEVAR presents a small risk of spinal cord ischemia. 4,[6][7][8] The aortic diameter is the most important anatomical consideration in aortic stenting, 6 and it has been established that the aortic diameter increases with advancing age. 9,10 However, the effect of TEVAR on the aortic diameter in patients with TTA has not been determined.…”