Mid- and Long-Term Results of Endovascular Treatment in Thoracic Aorta Blunt Trauma

Abstract

Study Aim. Evaluation of results in blunt injury of the thoracic aorta (BAI) endovascular treatment. Materials and Methods. Sixteen patients were treated for BAI. Thirteen patients had associated polytrauma, 4 of these had a serious hypotensive status and 4 had an hemothorax. In the remaining 3, two had a post-traumatic false aneurysm of the isthmus and 1 had a segmental dissection. In those 13 patients a periaortic hematoma was associated to hemothorax in 4. All patients were submitted to an endovascular treatment, in two cases the subclavian artery ostium was intentionally covered. Results. One patient died for disseminated intravascular coagulation. No paraplegia was recorded. No ischemic complications were observed. A type I endoleak was treated by an adjunctive cuff. During the followup (1–9 years) 3 patients were lost. A good patency and no endoleaks were observed in all cases. One infolding and 1 migration of the endografts were corrected by an adjunctive cuff. Conclusion. The medium and long term results of the endovascular treatment of BAI are encouraging with a low incidence rate of mortality and complications. More suitable endo-suite and endografts could be a crucial point for the further improvement of these results.

Traumatic isolated aortic dissection

“…Surgical approach to these patients involves a high posterolateral thoracotomy with or without cardiopulmonary bypass. Significant blood loss can negatively impact the pulmonary, cardiac, and neurologic status of the patient (2) .…”

“…Blunt traumatic thoracic aortic injury is associated with a high mortality rate and has been implicated as the second most common cause of death in trauma patients preceded only by intracranial hemorrhage (2) .…”

Thoracic aortic aneurysms after blunt trauma

“…Irace and colleagues [2] reported a series of 16 patients with chronic aortic aneurysm who underwent endovascular treatment. One mortality was reported due to disseminated intravascular coagulation.…”

“…Blunt non-penetrating aortic injuries are very mortal lesions, with a high mortality rate, with 80-90% dying in the first hour after the accident, and these injuries have been implicated as the second most common cause of death in the trauma patient. [1,2] In approximately 2% of these patients, though the injury is missed during the first admission, patients live long enough to develop a chronic aortic aneurysm, which signifies rupture. [3] These patients can present with general symptoms like cough, hoarseness and pain in the epigastrium or back years after the accident.…”

Management of simultaneous traumatic brain injury and aortic injury

“…The incidence of TBI/ aortic injury is likely underestimated because many patients with this pathology die prior to hospital admission or imaging studies. 16 Because TBI is the leading cause of death in all trauma patients, and aortic injury is the second most common cause of death in newer studies, 5,10,12 many physicians believe that TBI/aortic injury represents an unsurvivable condition. This assumption is supported by historical data showing that aortic injury alone carried a mortality rate of 80% in 1958.…”