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Emergency stent-graft placement for impending rupture of the descending thoracic aorta
H Joachim Nesser1, Holger Eggebrecht, Dietrich Baumgart
1Zweite Interne Abteilung mit Kardiologie und Angiologie, A.ö.Krankenhaus der Elisabethinen, Linz, Austria.
Insights
Emergent stent-graft placement offers a promising solution for patients experiencing impending aortic rupture due to intramural hematoma. This minimally invasive approach demonstrated successful outcomes with no complications in initial cases.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Radiology
Background:
- Intramural hematoma (IMH) of the descending thoracic aorta presents a high risk of rupture.
- Conventional surgical repair carries significant risks, especially in emergency settings.
- Minimally invasive endovascular techniques are increasingly explored for complex aortic pathologies.
Observation:
- Three patients with acute thoracic pain and IMH, showing signs of impending rupture, underwent emergent stent-graft placement.
- Diagnosis was confirmed using transesophageal echocardiography and computed tomography.
- Signs of impending rupture included pleural effusion, persistent pain, and transadventitial bleeding.
Findings:
- All three patients successfully underwent emergent stent-graft placement.
- No procedure-related complications were observed during or immediately after the intervention.
- Follow-up of up to 18 months showed no evidence of endoleak, with all patients remaining asymptomatic.
Implications:
- Emergent stent-graft placement is a viable and potentially safer alternative to open surgery for aortic rupture due to IMH.
- This endovascular approach may improve outcomes and reduce morbidity in high-risk patients.
- Further research and larger studies are warranted to confirm these initial promising findings.
Purpose:
To present initial experience with emergent stent-graft placement for impending rupture of the descending thoracic aorta.
Case Reports:
Intramural hematoma (IMH) of the descending thoracic aorta was diagnosed by transesophageal echocardiography and computed tomography in 3 patients with acute onset of severe thoracic pain. Because of signs of impending rupture, e.g., pleural effusion, sustained pain, or transadventitial bleeding, the patients underwent emergency stent-graft placement, which was successful in all cases. No procedure-related complications were observed. Follow-up to 18 months has revealed no evidence of endoleak, and all patients remain free of symptoms.
Conclusions:
Emergency stent-graft placement may be a promising alternative to conventional surgery in patients with impending aortic rupture due to IMH.