Treating Traumatic Thoracic Aortic Rupture An overview of endovascular options for patients with blunt traumatic rupture of the thoracic aorta

B lunt traumatic rupture of the thoracic aorta usually occurs at the isthmus and is a life-threatening surgical emergency. Blunt traumatic rupture lesions are usually the result of a violent motor vehicle accident and are frequently associated with other life-threatening traumatic injuries (ie, pulmonary contusions, head injuries, fractures, injuries of the solid organs); thus, 80% of the subjects who experience aortic rupture die at the scene of the accident.1 The management of patients who do reach the hospital remains a subject of controversy, both in terms of how the aorta should be repaired and the lapse of time between the traumatic injury and repair.2 THE STANDARD Open surgical repair is the gold standard. The procedure consists of either simply suturing the aorta or clamp-and-sew repair, with the interposition of a prosthetic graft, sometimes using an adjunct to maintain distal aortic perfusion and limit the distal impact of aortic cross-clamping. The immediate outcome of surgical repair is disappointing. Operative mortality varies from 8% to 15%, depending on the severity of the associated traumatic injuries. Circulatory assistance reduces the incidence of medullary ischemia to 3%; however, it has the drawback of requiring systemic heparinization, thereby increasing the risk of fatal hemorrhage, particularly in patients with cerebral or pulmonary contusions.3,4 Treating Traumatic Thoracic Aortic Rupture