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Endovascular treatment of traumatic descending aortic lesions: nine years of experience
Emanuela de Cillis1, Vito Paradiso, Ayman Elmeghory
1Department of Emergency and Organs Transplantation, University of Bari, Bari, Italy.
Insights
Endovascular repair using stent-grafts is a highly successful treatment for traumatic aortic lesions, offering a less invasive alternative to open surgery. This method showed no mortality or leakage in a 10-year study, making it the preferred choice for aortic injury.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Vascular Endourology
Background:
- Traumatic aortic injury, often resulting from sudden deceleration, is a critical condition.
- Conventional open surgical repair carries significant risks and high morbidity.
- Stent-graft treatment presents a less invasive alternative for traumatic aortic lesions.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular repair for traumatic aortic lesions.
- To compare endovascular repair outcomes with conventional surgical risks.
Main Methods:
- A retrospective analysis of 57 patients with acute and chronic aortic lesions treated with endovascular repair from March 1999 to June 2009.
- Inclusion criteria: diagnosis of acute or chronic aortic lesions.
- Assessment of treatment success, mortality, and perigraft leakage during follow-up.
Main Results:
- Successful endovascular repair in all 57 patients, regardless of acute or chronic injury phase.
- No mortality observed during the follow-up period.
- Zero cases of perigraft leakage reported.
Conclusions:
- Endovascular repair is the primary treatment of choice for traumatic aortic lesions.
- This approach avoids the high morbidity associated with thoracotomy and conventional surgery.
- It is particularly beneficial for patients with multiple associated lesions that could be worsened by open surgery.
Abstract:
Aortic injury from sudden deceleration is the most common traumatic condition of the thoracic aorta encountered clinically. Open surgical repair is still associated today with a high-risk setting. Recently, stent-graft treatment is emerging as an alternative to conventional surgery due to its less traumatic nature in patients affected by traumatic aortic lesions, especially in concomitance with multiple associated lesions. From March 1999 to June 2009, 57 patients admitted with a diagnosis of acute and chronic aortic lesions underwent endovascular repair. In 38 cases, traumatic aortic rupture was detected in the acute phase and associated lesions were present at various grade in all patients, whereas in 19 cases aortic injury was identified in the chronic phase. The endovascular treatment was successful in all cases affected both by acute and chronic aortic injury. None of the patients died during the follow-up, as well as no cases of perigraft leakage have been detected so far. Endovascular repair represents the first choice of treatment in patients with traumatic aortic lesions. Indeed, the severity of co-existing lesions could be adversely affected by conventional surgical treatment, also with consideration of its high morbidity rate due to thoracotomy.
