Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…The latter complication was fatal in 30% of cases. 160 Most TAI occur in young patients, who are more likely to have acute curvature of the aortic arch. This anatomical variant may limit the optimal apposition of the stent graft to the inner aortic curvature, leading to "bird beaking" and an increased risk of endoleak and stent collapse.…”

“…164 The necessity of LSA coverage during TEVAR for TAI was reported in 30% of cases in recent reviews. 150,160 As in other pathological situations, in the emergency setting LSA revascularisation is recommended in patients with left internal mammary artery to coronary artery bypass, and when the presence of a dominant left vertebral artery assures a better posterior cerebral perfusion compared with the right 49,129 (see also Sections 2.4.2. and 3.1.3.2.2.). A separate consideration should be applied to chronic post-traumatic pseudoaneurysms, which have different anatomical characteristics from degenerative aneurysms, in that they are typically localised, calcified saccular lesions located just distal to the LSA, making them attractive targets for endovascular repair.…”

Endovascular treatment for acute traumatic thoracic aortic transection

“…[2] In a literature review, the incidence of stroke or transient ischemic attack has been reported as 1.2%. [7] We didn't observe paraplegia or any ischemic complications in our patient group. In the same review, the incidence of early and late endoleak after endovascular treatment has been reported as 4.2% and 0.9%, respectively.…”

“…In the same review, the incidence of early and late endoleak after endovascular treatment has been reported as 4.2% and 0.9%, respectively. [7] Our technical success was 100% without any types of endoleak.…”

“…Endovascular aortic stenting may reduce mortality and paraplegia rates by half compared with open surgery, whichmakes endovascular treatment the firstline therapy for blunt thoracic aortic trauma. [7] Rates of stent-graft collapse after endovascular treatment has been reported between 0.03% and 10% in the literature. [4] Excessive oversizing of the stent-graft and acute angle of the aortic arch are the factors that can lead to stent collapse.…”