Endovascular Repair of Traumatic Thoracic Aortic Disruption

Abstract

In a patient with multiple trauma, blunt thoracic trauma with concomitant aortic disruption is often eminently lethal, ranking second to head injury as the most common cause of trauma-related deaths. Open surgical repair of the aortic lesion has morbidity and mortality rates that are among the highest in the field of cardiovascular surgery. Results with thoracic endovascular aortic repair for traumatic aortic disruption are promising. The facility requirements, technique, and early results of thoracic endovascular aortic repair for the treatment of this difficult aortic injury are presented.

Transient Paraplegia in a Patient with Bilateral Posterior Frontal Contusions and Traumatic Thoracic Aortic Dissection

“…4 Up to 90% of patients suffering blunt aortic injury (BAI) expire before reaching a hospital; and of those that do, another half dies within 24 hours. 13,8,11,9 BAI also carries a significant morbidity, including spinal cord ischemia and stroke reported as high as 20% and 8% respectively. 5 Spinal cord ischemia can be the direct result of aortic injury or can be the complication of open and endovascular repairs of the aortic injury.…”

Transluminal endovascular aortic repair and pregnancy: a case report

“…Pregnancy in patients survivors after ATAT is very rare because of the extremely high mortality rate associated to this traumatic event (up to 85-90% of these patients die at the time of the injury and 20-30% during surgery or diagnostic procedure) [2].…”

Endovascular Repair of Thoracic Aortic Injury: Current Thoughts and Technical Considerations

“…For one, it cannot be emphasized enough just how critical the endovascular operating team and procedure facility are to quality outcomes. 3 Appropriate endovascular inventories, imaging, and around the clock accessibility are crucial in making this unique trauma therapy available.…”

“…Prior to deployment in this high-pressure, high-flow area, the blood pressure should be lowered to a mean arterial pressure of 50 to 70 mm Hg. 3,6,11 This allows for deployment without a billowing effect on the flowering, expanding graft and more accurate placement. Early in thoracic endografting, many found this to be a significant problem in achieving successful treatment.…”

“…1 Fully 75 to 90% of those sustaining blunt aortic injury (BAI) expire in the prehospital setting, and only half of those surviving transport to a hospital will live more than 24 hours. [2][3][4][5][6][7][8] The observed natural history shows that, once in the hospital, the majority of those who will succumb do so in the first several hours after admission unless treatment is initiated. In this group, two-thirds of deaths are directly attributable to aortic rupture.…”