Surgical treatment of acute traumatic rupture of the thoracic aorta a timing reappraisal?

Langanay, Thierry; Verhoye, Jean‐Philippe; Corbineau, Hervé; Agnino, Alfonso; Derieux, Thierry; Ménestret, P; Logeais, Y; Leguerrier, Alain

doi:10.1016/s1010-7940(01)01133-2

Cited by 50 publications

(24 citation statements)

References 22 publications

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“…In this study, however, endovascular repair was performed immediately after trauma or as early as possible. Langanay et al reported 20% of 50 patients with delayed surgical treatment between 6 and 60 days because of late diagnosis or coexisting life-threatening lesions without further aortic rupture or sudden death [17].…”

Section: Discussionmentioning

confidence: 99%

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Buz¹,

Zipfel²,

Mulahasanovic³

et al. 2008

European Journal of Cardio-Thoracic Surgery

106

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Objective: Endoluminal aortic stent grafting offers a potentially less invasive alternative to open chest surgery, especially in patients with polytrauma. We compare the results of conventional surgical repair and endovascular treatment of traumatic aortic rupture. Methods: Retrospectively, 74 patients with acute traumatic aortic rupture were analyzed. Most of the patients had a rupture limited to the isthmus, and severe associated injuries. Thirty-five patients (6 female, 29 male, mean age 36 years) underwent surgical repair. Two patients were operated upon without cardiopulmonary bypass. In 39 patients (5 female, 34 male, mean age 36 years) thoracic endografts were implanted. The delay between trauma and treatment was comparable in the two groups. Results: Hospital mortality was 20% (7 of 35 patients) in the surgical group and 7.7% (3 of 39 patients) in the endovascular group. The most common cause of death in the surgical group was brain death in severe traumatic patients. Ten surgical complications occurred in 5 patients: respiratory insufficiency (n = 3), pulmonary infection (n = 2), recurrent nerve palsy (n = 2), repeat thoracotomy (n = 2), and compartment syndrome (n = 1). No patient in this group had paraplegia. Except for one case, which required conversion to conventional surgery, stent-graft implantation was successful in all cases, without peri-interventional complications or procedure-induced paraplegia. In 9 patients the left subclavian artery was covered with the device. Two patients underwent surgical repair 15 days and 4 months after endografting because of injury of the aortic wall by the stent and development of a spurious aneurysm, respectively. Conclusions: In the treatment of traumatic thoracic aortic rupture, the early outcome of patients treated with endovascular stent grafts appears to be better than that with conventional surgical repair. The new technique allows safe and successful repair of this life-threatening injury in the early phase of trauma management. How far this potential benefit is sustained in the long term remains unclear at present. #

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Section: Discussionmentioning

confidence: 99%

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Buz¹,

Zipfel²,

Mulahasanovic³

et al. 2008

European Journal of Cardio-Thoracic Surgery

106

View full text Add to dashboard Cite

show abstract

“…Duwayri and colleagues are in accordance with the above authors and advocate delayed repair in hemodynamically stable patients as this was not associated with increased risk of aortic rupture in their small study in 2008 [37]. Surgery was delayed (>24 h) in 6 out of 9 patients who were hemodynamically stable and mortality in this group was zero [38].…”

Section: Evidencementioning

confidence: 52%

“…Multiple trauma patients have always been challenging with regards to the right order and timing of different interventions. A widely accepted definition of delayed repair does not exist in the literature; studies have used different timeframes to define their ''delayed repair'' group such as 16 h, 24 h, 72 h or even a few days post-injury [35][36][37][38][39].…”

Section: Evidencementioning

confidence: 99%

“…An early paper by Langanay et al in 2002, calls for reappraisal of the timing of treatment and strongly supports delaying the intervention (OR) where possible [37]. Out of 50 patients who presented at their centre between 1976 and 1990, 10 underwent a delayed open repair (6-60 days post-injury) either due to late diagnosis or coexisting life-threatening lesions that substantially increased the operative risk.…”

Section: Evidencementioning

confidence: 99%

“…Notably, there were no sudden deaths or aortic ruptures in this group of patients. The authors conclude that the choice for the immediate management of patients with acute traumatic aortic rupture should largely depend on the associated injuries, as these could be worsened by the use of cardiopulmonary bypass, and additionally on the need for lifesaving measures [37].…”

Section: Evidencementioning

confidence: 99%

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