Objective: Post-traumatic aortic rupture is a potentially lethal injury. Stentgraft repair has recently proved to be a valid option for these patients. Timing of the treatment, anyway, is still a debated issue. We here report mid-term results of our experience with immediate stent graft repair. Methods: From 1998 to 2006 17 patients (12 males, five females) with blunt aortic injury were submitted to immediate endovascular repair. In ten patients with clinical and radiological signs of impending rupture stent grafting was performed on an emergency setting. In the remaining seven patients aortic lesion was treated urgently after clinical management. When present, immediate life-threatening non-aortic lesions were treated before endovascular treatment (seven cases). In one case emergent laparotomy and stent positioning were performed simultaneously. Endovascular procedure was carried out in a cardiac surgery operating theatre and monitored by trans-oesophageal echocardiography in all cases. Results: Stent grafting was successful in 100% of the patients. Two patients died perioperatively as a consequence of a multi-organ failure. Both patients were in ASA class V and presented severe intractable hemorrhagic shock before procedure. CT scan performed before discharge showed correct positioning of the stent-graft and absence of endoleaks in all cases. At a mean follow-up of 36 months (range 1–72) all patients are alive and no intervention related complication occurred. Conclusions: Immediate endovascular repair of blunt aortic injury is a feasible and safe procedure. Mid-term results are promising. Longer follow-up and larger series are mandatory to definitively validate this approach.
Immediate endovascular treatment of blunt aortic injury: mid-term results
BEGHI, CESARE;
2007-01-01
Abstract
Objective: Post-traumatic aortic rupture is a potentially lethal injury. Stentgraft repair has recently proved to be a valid option for these patients. Timing of the treatment, anyway, is still a debated issue. We here report mid-term results of our experience with immediate stent graft repair. Methods: From 1998 to 2006 17 patients (12 males, five females) with blunt aortic injury were submitted to immediate endovascular repair. In ten patients with clinical and radiological signs of impending rupture stent grafting was performed on an emergency setting. In the remaining seven patients aortic lesion was treated urgently after clinical management. When present, immediate life-threatening non-aortic lesions were treated before endovascular treatment (seven cases). In one case emergent laparotomy and stent positioning were performed simultaneously. Endovascular procedure was carried out in a cardiac surgery operating theatre and monitored by trans-oesophageal echocardiography in all cases. Results: Stent grafting was successful in 100% of the patients. Two patients died perioperatively as a consequence of a multi-organ failure. Both patients were in ASA class V and presented severe intractable hemorrhagic shock before procedure. CT scan performed before discharge showed correct positioning of the stent-graft and absence of endoleaks in all cases. At a mean follow-up of 36 months (range 1–72) all patients are alive and no intervention related complication occurred. Conclusions: Immediate endovascular repair of blunt aortic injury is a feasible and safe procedure. Mid-term results are promising. Longer follow-up and larger series are mandatory to definitively validate this approach.
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