Endovascular stent-graft implantation in acute traumatic aortic dissection with contained rupture and hemorrhagic...

Traumatic dissections of the thoracic aorta with consecutive organ ischemia are emergencies with an enormously high mortality despite immediate surgical therapy. Successful therapy of a thoracic aortic aneurysm by percutaneous implantation of a stent graft prosthesis was first reported in 1994. In recent years endovascular methods have been used increasingly for the treatment of acute aortic syndromes.

After a traffic accident, a 33 year old motorcycle rider was admitted to our emergency unit conscious with clinical signs of hemorrhagic shock. His lower extremities were pulseless and paraplegia of the legs had already developed. An immediate angio-CT scan demonstrated a contained rupture of the aortic wall with mediastinal hematoma caused by a dissection beginning in the aortic arch. In the cathlab the right femoral artery was exposed and an angiography was performed showing a complete interruption of aortic blood flow caused by the transection. Under angiographic control an endovascular self-expanding nitinolstent (Talent Stent Graft, Medtronic) was implanted into the descending aorta. After moderate balloon inflation at the proximal entry, the rupture was completely closed and perfusion was restituted. The further clinical course was complicated by rhabdomyolysis necessitating additional subtotal arm amputation. Spinal ischemia resulted in persisting paraplegia of the legs.

An urgent treatment of a contained rupture of the descending aorta with consecutive organ ischemia by endovascular implantation of stent graft prosthesis is technically possible. Advantages are a less invasive procedure and rapid restitution of blood flow.