TY - JOUR
T1 - Endovascular repair of traumatic descending thoracic aortic disruptions
T2 - Should endovascular therapy become the gold standard?
AU - Uzieblo, Matt
AU - Sanchez, Luis A.
AU - Rubin, Brian G.
AU - Choi, Eric T.
AU - Geraghty, Patrick J.
AU - Flye, M. Wayne
AU - Curci, John A.
AU - Moon, Marc R.
AU - Sicard, Gregorio A.
PY - 2004
Y1 - 2004
N2 - Acute arterial disruptions of the thoracic aorta are rare and often lethal. They are most often due to blunt trauma and occur most commonly just distal to the left subclavian artery origin in the setting of multisystem injuries. The very proximal nature of the lesion in survivors makes open surgical repair hazardous, with mortality rates reaching over 20%. Endovascular therapy is a new and attractive option for the treatment of those challenging patients. Since March 2002, 3 patients with blunt and 1 patient with a stable iatrogenic descending aortic injury were successfully treated at this institution. Spiral computed tomography followed by angiography was used for diagnosis. No preexisting aortic pathology was present. Major associated injuries included unstable thoracic spinal fractures, abdominal solid organ injuries, and hip fractures, making the subjects poor surgical candidates. The Talent Endovascular Graft was deployed via open femoral or iliac artery access under fluoroscopic guidance. All 4 patients underwent successful exclusion of their thoracic pseudoaneurysm with use of the Talent endovascular graft. One patient required partial coverage of the left subclavian artery, and a second patient had an iliac artery stent deployed after traversal of an area of stenosis with the delivery system. There were no cardiac, neurologic, pulmonary, or peripheral vascular complications. Acute aortic disruption, with its associated high surgical morbidity and mortality, is an excellent indication for endovascular therapy to improve patient outcomes. More long-term data are needed on repair durability.
AB - Acute arterial disruptions of the thoracic aorta are rare and often lethal. They are most often due to blunt trauma and occur most commonly just distal to the left subclavian artery origin in the setting of multisystem injuries. The very proximal nature of the lesion in survivors makes open surgical repair hazardous, with mortality rates reaching over 20%. Endovascular therapy is a new and attractive option for the treatment of those challenging patients. Since March 2002, 3 patients with blunt and 1 patient with a stable iatrogenic descending aortic injury were successfully treated at this institution. Spiral computed tomography followed by angiography was used for diagnosis. No preexisting aortic pathology was present. Major associated injuries included unstable thoracic spinal fractures, abdominal solid organ injuries, and hip fractures, making the subjects poor surgical candidates. The Talent Endovascular Graft was deployed via open femoral or iliac artery access under fluoroscopic guidance. All 4 patients underwent successful exclusion of their thoracic pseudoaneurysm with use of the Talent endovascular graft. One patient required partial coverage of the left subclavian artery, and a second patient had an iliac artery stent deployed after traversal of an area of stenosis with the delivery system. There were no cardiac, neurologic, pulmonary, or peripheral vascular complications. Acute aortic disruption, with its associated high surgical morbidity and mortality, is an excellent indication for endovascular therapy to improve patient outcomes. More long-term data are needed on repair durability.
UR - http://www.scopus.com/inward/record.url?scp=4043172849&partnerID=8YFLogxK
U2 - 10.1177/153857440403800404
DO - 10.1177/153857440403800404
M3 - Article
C2 - 15306950
AN - SCOPUS:4043172849
SN - 1538-5744
VL - 38
SP - 331
EP - 337
JO - Vascular and Endovascular Surgery
JF - Vascular and Endovascular Surgery
IS - 4
ER -