Endovascular management of traumatic thoracic aortic injuries.

نویسندگان

  • D Kirk Lawlor
  • Michael Ott
  • Thomas L Forbes
  • Stewart Kribs
  • Kenneth A Harris
  • Guy DeRose
چکیده

BACKGROUND Endovascular surgery has recently been extended to the treatment of blunt traumatic aortic injuries. Since most of these injuries occur at the aortic isthmus, graft fixation in proximity to the origin of the left subclavian artery (LSA) has been a concern. Covering the LSA with graft fabric lengthens the proximal fixation site and should minimize proximal endoleaks. We therefore wished to evaluate the feasibility and safety of endovascular repair of thoracic aortic injuries after blunt trauma, both with and without deliberate coverage of the LSA. METHODS At a tertiary care teaching hospital in London, Ont., we reviewed our experience with endovascular repair of 7 traumatic aortic injuries. We reviewed the technical success rate and the incidence of left subclavian coverage. Major morbidity, including rates of paraplegia and death were noted. The patients were followed-up with serial CT to look for endoleaks, stent migration or aneurysm growth and to determine whether they had symptoms related to left subclavian coverage. RESULTS The time from injury to treatment ranged from 7 hours to 7 days (mean 36 h). The mean Injury Severity Score was 36. All injuries were at the aortic isthmus, and among the 7 patients treated, 6 had deliberate coverage of the LSA. One patient underwent carotid-to-subclavian artery bypass, but the other 5 did not. There were no cases of paraplegia; 1 patient had symptoms of claudication in the left arm but did not want revascularization. No procedure-related complications occurred, and all patients survived the event. Follow-up ranged from 2 to 30 (mean 13) months, and no endoleaks, stent migration or aneurysm expansion were noted in follow-up. CONCLUSIONS Although long-term results are unknown, we conclude that endovascular repair of traumatic aortic injuries after blunt trauma can be performed safely with low morbidity and mortality and that coverage of the LSA without revascularization is tolerated by most patients.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Late lumen loss in thoracic aortic end graft after endovascular procedure of a traumatic pseudoaneurysm

We report the case of a 23-year-old woman who died due to endograft stenosis 20 months after thoracic endovascular aortic repair. The patient presented with the pseudocoarctation syndrome. Although angioplasty of stenosis endograft was successfully performed, severe metabolic complications were lethal.

متن کامل

Endovascular Stent in Traumatic Thoracic Aortic Dissection

Traumatic thoracic aortic injury is typically fatal. However, recent improvements in pre-hospital care and diagnostic modalities have resulted in an increased number of patients with traumatic aortic injury arriving alive at the hospital. Also, the morbidity and mortality associated with endovascular repair are significantly lower than with conventional open surgery in traumatic thoracic aorta ...

متن کامل

Endovascular repair of traumatic pseudoaneurysm of the descending thoracic aorta: report of three cases and review of

 Abstract Traumatic descending thoracic aorta pseudo aneurysms have been treated traditionally with open surgery in the past, which have had noticeable rates of mortality and morbidity. A safer method of treatment for this disease is made possible with recent progress in endovascular treatment techniques. In this article, we present three cases of Traumatic descending thoracic aorta pseudo aneu...

متن کامل

AORTIC TRANSECTION AND ITS SURGICAL REPAIR: A CASE REPORT FROM IRAN

Aortic transection is a rare but life-threatening complication of blunt chest trauma. Treatment options include open repair, medical management and most recently, endovascular repair. We report a 33 years old male with a traumatic aortic transection following a car accident. Aortic injury and its pseudo-aneurysm were confirmed by Chest CT scan and TEE in the descending thoracic aorta just belo...

متن کامل

The role of CT angiography in the diagnosis of blunt traumatic thoracic aortic disruption and unsuspected carotid artery injury.

We have replaced aortography and open thoracic surgery to diagnose and treat blunt traumatic thoracic aortic disruption (TTAD) in favor of CT angiography (CTA) and endovascular repair. The purpose of this study is to review our experience with the management and outcomes of TTAD and associated carotid artery injuries. In January 2003, we initiated a protocol that used CTA to evaluate all patien...

متن کامل

Acute Traumatic Thoracic Aortic Injury: Considerations and Reflections on the Endovascular Aneurysm Repair.

Traumatic rupture of the thoracic aorta is a life-threatening lesion and it occurs in 10 to 30% of fatalities from blunt thoracic trauma and is the second most common cause of death after head injury. Immediate surgery is often characterized by a high mortality and morbidity rate. Delayed repair of traumatic aortic injuries has significant survival benefits and a much lower mortality rate compa...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Canadian journal of surgery. Journal canadien de chirurgie

دوره 48 4  شماره 

صفحات  -

تاریخ انتشار 2005