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Thoracic endovascular aortic repair for traumatic aortic transection
Michael R Go1, Joel E Barbato, Ellen D Dillavou
1Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical School, Pittsburgh, PA 15213, USA.
Journal of Vascular Surgery
|November 6, 2007
Summary
Thoracic endovascular aortic repair (TEVAR) is a feasible treatment for traumatic aortic transection, showing good initial success and survival. Careful consideration is needed for this off-label use in younger patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Endovascular Therapy
- Trauma Surgery
Background:
- Traumatic aortic transection is a severe injury often requiring delayed treatment due to concurrent injuries.
- Thoracic endovascular aortic repair (TEVAR) is an effective treatment option, though its use in young patients with traumatic injuries is debated.
Purpose of the Study:
- To review the experience with acute and subacute thoracic endovascular aortic repair (TEVAR) for traumatic aortic transection.
- To evaluate the feasibility, safety, and outcomes of TEVAR in this patient population.
Main Methods:
- A retrospective analysis of 10 patients (5 male, 5 female) who underwent TEVAR for aortic transection between 1999 and 2007.
- Standard endovascular techniques were employed, with computed tomography follow-up at 1 month and annually thereafter.
Main Results:
- The mean age was 44 years, with injuries resulting from motor vehicle accidents, snowmobile accidents, skydiving, and balloon angioplasty.
- Immediate technical success was 90% with no 30-day mortality. One endoleak resolved spontaneously. A single device complication (endograft collapse) led to aortoesophageal fistula requiring further intervention.
- Mean follow-up was 20 months, with all patients alive and well. No iliac injuries were reported.
Conclusions:
- TEVAR is a feasible and successful treatment for traumatic aortic transection, with potential for delayed repair in select cases.
- Continued surveillance is crucial for long-term outcomes, especially in younger patients.
- Caution is advised as TEVAR devices are designed for aneurysm diameters, not traumatic transections.
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