Endovascular stent-graft for blunt thoracic aortic rupture: a novel and useful approach in selected cases.

' 2003 Canadian Medical Association Blunt thoracic aortic rupture (BTAR) is a life-threatening injury that is responsible for 15% to 23% of deaths from motor vehicle crashes. Most victims die at the scene from exsanguination, but 15% to 20% reach the hospital alive because the rupture is contained by the aortic adventitia and the surrounding mediastinal structures. Up to 80% of patients with BTAR have concomitant injuries such as pulmonary contusion, neurologic trauma and intra-abdominal or pelvic hemorrhage. The accepted management of patients with BTAR comprises prompt diagnosis, evaluation and treatment of other lifethreatening injuries followed by open aortic repair. Early open aortic repair in the presence of associated injuries increases operative mortality and morbidity. Death after open surgical repair of BTAR ranges from 7% to 28% with a 4% to 36% risk of paraplegia. Recently, placement of an endovascular stent-graft has been proposed as an alternative to open surgical repair for BTAR, and excellent early results have been reported. We describe our experience with 3 cases of BTAR managed with endovascular stent-grafts and discuss the indications and the management issues related to this procedure.