Traumatic thoracic aortic aneurysm: treatment with endovascular stent-grafts.

Kato, Noriyuki; Dake, Michael D.; Miller, D. Craig; Semba, Charles P.; Mitchell, R. Scott; Razavi, Mahmood K.; Kee, Stephen T.

doi:10.1148/radiology.205.3.9393517

Cited by 309 publications

(172 citation statements)

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“…Traumatic injury of the aorta is usually immediately fatal; 57%-94% of these patients die at the scene or in the emergency room (1,2). Furthermore, the mortality rate for patients with aortic rupture who survive until they reach the hospital is estimated to be 41%-50% (3).…”

Section: Resultsmentioning

confidence: 99%

Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience

İslim

Salık²,

Güven³

et al. 2014

Diagn Interv Radiol

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consecutive patients (nine males, two females; age range, 26-80 years) with thoracic and abdominal aortic ruptures underwent endovascular repair in our unit. Thoracoabdominal computed tomography (CT) angiography was performed for diagnosis and follow-up. Patients were selected for endovascular repair by a cardiovascular surgeon, anesthesiologist, and interventional radiologist. All repairs were performed using commercially available stent-grafts. The patients were followed up with CT angiography before discharge, at six months, and yearly thereafter. RESULTSThree patients died by day 30. One patient died due to an unsuccessful procedure and hemodynamic instability; two patients died because of comorbidities. The other eight patients were followed for six to 24 months after the procedure. No endoleaks or late ruptures were observed during the follow-up period. The patient with iatrogenic thoracic aortic rupture developed paraplegia after the procedure. CONCLUSIONReduced mortality due to aortic rupture has been reported with the expanding use of endovascular repair. Reports of small centers are important because of the rarity of these pathologies, and because transferring patients with aortic rupture to a referral center is not usually possible.

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Section: Resultsmentioning

confidence: 99%

Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience

İslim

Salık²,

Güven³

et al. 2014

Diagn Interv Radiol

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“…The interval between the trauma and diagnosis used in the literature to differentiate acute and chronic traumatic aortic injuries is not clear, varying between 36 hours and 3 months. [7,8] The interval between the trauma and diagnosis of a pseudoaneurysm may change. In a group of 10 patients operated for traumatic thoracic aortic aneurysms, Buket et al [9] reported this period to be between 1 day and 10 years.…”

Section: Discussionmentioning

confidence: 99%

Thoracic aortic aneurysms after blunt trauma

Taşoğlu¹,

Sert²,

Lafçı³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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“…Both Semba et al 13 and Kato et al 14 have reported endovascular stent -graft treatment of acute traumatic rupture with low mortality and no neurologic complications. The good operative results in the present and other series 15,16 attest to the worth of considering this treatment as the first choice for BAI with severe associated complications.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Stent-Graft Treatment for Blunt Aortic Injury

Kato

Sato

et al. 2004

Circ J

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lunt aortic injury (BAI) is a life-threatening complication of chest trauma. Approximately 85% of patients die at the scene of the accident 1 and patients who arrive at hospital alive frequently have associated lesions such as cerebrospinal trauma, abdominal trauma, or multiple bone fractures. The standard surgical technique for BAI requires left posterolateral thoracotomy, singlelung ventilation, proximal aortic cross-clamping, and use of cardiopulmonary bypass (CPB) or left atriofemoral shunt for preventing ischemic, neurologic, and visceral complications during the cross-clamping. Despite the recent advances in surgical and circulatory assistance techniques, postoperative mortality ranges from 15% to 30%. [1][2][3][4] The presence of severe associated injuries precludes the massive systemic heparinization required for circulatory assistance and thus makes conventional surgery very risky. Several reports have recently demonstrated the safety and efficacy of endoluminal grafting in thoracic aortic diseases 5-10 and we report here on the emergency or semiemergency repair of 6 cases of BAI successfully treated with an endoluminal stent -graft. Methods Patient SelectionFrom January 2002 to October 2003, 6 patients were admitted with a BAI. Two patients had been in automobile accidents, 1 in a motorcycle accident, and 3 had fallen (Table 1). Three of the patients were male and the age range was 18-57 years (mean, 34.5 years).In 5 patients the BAI was diagnosed by computed tomo- Circulation Journal Vol.68, June 2004graphy (CT) in the emergency room after clinical suspicion was raised by symptoms and/or chest radiograph findings. One patient was treated as a BAI 7 days after the accident because of delayed diagnosis of a periaortic hematoma. The indication for the stent -graft procedure was the presence of serious comorbidities, such as severe pulmonary contusions, closed head injury, spinal cord injury, and pelvic fracture, that made open surgical repair extremely risky (Table 1). Preoperative workup included spiral CT scan of the chest, transesophageal echography (TEE), and subtraction angiography of the thoracic aorta. During the same period as this series, we performed 4 open repairs for BAI (age range, 17-67) because those patients were considered a low risk for open surgery, having either few associated injuries (3 patients) or a long interval (8 years) after the original trauma (1 patient). Stent -GraftThe dimensions of the stent -graft were determined from the CT and angiography images (Fig 1a-c). The precise diameters proximal and distal to the injured aorta were measured using the CT built-in scale of straight line distance for CT (Hispeed Advantage SG: GE Medical Systems, Milwaukee, WI, USA). We confirmed these diameters using intraoperative angiography with a measuring guidewire. The graft was oversized by 10% compared with the normal, adjacent aorta and in this series, the average stent -graft diameter was 23 mm (range, 18-26 mm), and average length was 92 mm (range, 58-110 mm).The homemade stent -graft ...

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Traumatic thoracic aortic aneurysm: treatment with endovascular stent-grafts.

Abstract: Transluminal placement of endovascular stent-grafts is a technically feasible method for treatment of traumatic thoracic aortic aneurysm and may be an effective alternative to open-chest surgery.

Cited by 309 publications

References 0 publications

Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience

Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience

Thoracic aortic aneurysms after blunt trauma

Endovascular Stent-Graft Treatment for Blunt Aortic Injury

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