Endovascular Repair of Blunt Traumatic Thoracic Aortic Injuries

Abstract

Thoracic endovascular aortic repair, via a percutaneous groin approach and without systemic anticoagulation, for blunt thoracic aortic injury can be performed safely with low periprocedural mortality and morbidity.

Endovascular repair of blunt aortic injury in a patient with situs inversus and dextrocardia

“…5,6 Treatment has traditionally involved open surgery with aortic cross-clamping and is associated with significant mortality and morbidity, including bleeding from anticoagulation, thoracotomy, and single-lung ventilation, as well as paraplegia. 6,7 Endovascular repair has become a safe and satisfactory method of aortic repair in selected patients. [5][6][7][8] The Talent endograft has been our endograft of choice.…”

“…6,7 Endovascular repair has become a safe and satisfactory method of aortic repair in selected patients. [5][6][7][8] The Talent endograft has been our endograft of choice. The bare metal stent allows accurate placement in the proximal landing zone with a lower risk of compromise to the carotid artery.…”

Percutaneous Interventions in Aortic Disease

“…In a 7-year follow-up of 24 patients, there were 2 vascular access site complications (8%) that required an iliofemoral bypass in 1 patient and a thrombectomy in another. 84 This series demonstrates that the adaptation of commercially available stent graft devices to treat blunt thoracic aortic injury is technically feasible and can be performed entirely percutaneously with low rates of morbidity and mortality.…”

Vascular Trauma: New Directions in Screening, Diagnosis and Management

“…Technical success rates range from 92-100%; with complications occurring in 0-15%; leaks, when reported, range from 0-15%; and mortality ranges between 0-17.9% (Alsac, et al, 2008;Asmat, et al, 2009;Canaud, et al, 2008;Day & Buckenham. 2008;Dunham, et al, 2004;Ehrlich, et al, 2009;Garcia-Toca, et al, 2010;Moainie, et al, 2008;Oberhuber, et al, 2010;Rahimi, et al, 2010;Urgnani, et al, 2009). The leak rate may increase with time, as several studies have shown an increase in need for second intervention with follow up among TEVAR patients compared to open repair (Hershberger, et al, 2009;Lee, et al, 2011;Tang, et al, 2008).…”

“…Additionally, when recorded the rate of stent coverage of the subclavian or carotid artery origin ranged from 50-85% (Alsac, et al, 2008;Asmat, et al, 2009;Canaud, et al, 2008;Day & Buckenham. 2008;Dunham, et al, 2004;Ehrlich, et al, 2009;Garcia-Toca, et al, 2010;Oberhuber, et al, 2010;Rahimi, et al, 2010;Urgnani, et al, 2009). Coverage of the origin of these great vessels has been associated with a risk of neurologic complication in 5.6% of patients, a rate that appears to be decreased with prophylactic re-vascularization (Hershberger, et al, 2009).…”