Acute traumatic rupture of the descending thoracic aorta: endovascular treatment.

BACKGROUND

Acute traumatic rupture of the descending thoracic aorta is usually considered a surgical emergency; a conventional surgical approach carries high morbidity and mortality rates in the perioperative period. Endovascular surgery has recently been considered as providing a new therapeutic strategy for these patients. The aim of our study was to evaluate the feasibility along with early and midterm results of this procedure in our experience.

METHODS

Among 59 thoracic stent-graft procedures performed between May 2001 and May 2005 in our Department, 11 male patients (mean age 48+/-7.3 years) underwent endovascular repair for acute traumatic rupture of the descending thoracic aorta caused by motor vehicle accidents. The feasibility of endovascular repair and the size of the endograft were assessed on the basis of urgent spiral computed axial tomography. In all cases, the lesion was limited to the isthmus. Follow-up was performed at discharge, at 3, 6, and 12 months, and yearly thereafter by clinical examination, chest x-ray, and computed axial tomography scan.

RESULTS

Technical success was obtained in all patients, and no conversion to open repair was necessary. No intraoperative deaths or complications occurred, and no patient developed temporary or permanent neurologic deficits in the postoperative period. One patient died 22 days after the procedure from acute respiratory failure; cumulative 30-day mortality rate was 9.1%. The mean follow-up duration was 18.2+/-4.5 months. No death, endoleak, or reintervention occurred during follow-up.

COMMENTS: The treatment of acute traumatic rupture of the descending thoracic aorta with stent graft is a feasible and safe technique; it provides low morbidity and mortality rates in the early postoperative period, and midterm results are encouraging. However, long-term studies are worthwhile to evaluate the effectiveness and the durability of this procedure.