Single-center experience with endovascular treatment of acute blunt thoracic aortic injuries

Endovascular repair of the thoracic aorta (TEVAR) has been recently considered an appealing alternative to open treatment of traumatic aortic injuries. However, the use of this technique in emergency is often limited by hemodynamic instability, severe associated lesions and unavailability of adequate materials. Dedicated stent-grafts are not currently available. We report our results in treating blunt traumas of the thoracic aorta using three different commercially available stent-grafts. METHODS Between 2003 and 2010, 28 patients (22 males, mean age 38.9±12.1 years) underwent TEVAR for a traumatic aortic lesion. A total-body computed tomography angiography (CTA) was performed in all cases to establish the diagnosis of aortic rupture and evaluate associated injuries. After TEVAR, patients were followed-up with CTA of the chest before discharge from the hospital, at 6 months and yearly thereafter.

Fifteen patients (54%) were hemodynamically unstable at presentation, and 20 patients (71%) presented severe associated lesions. The mean injury severity score (ISS) was 36.2. Twenty-four patients were treated emergently, whereas four patients underwent prior clinical stabilization of severe associated injuries. Primary technical success rate was 100%. No patient required conversion to open thoracic surgical repair. No paraplegia or stroke was observed. Procedure-related complications included an external iliac artery lesion during introducer sheath removal. The left subclavian artery was intentionally covered in 7 cases (25%), and revascularized in two hemodynamically stable patients prior to stent-graft deployment. Two patients died perioperatively due to multiorgan failure, for a total in-hospital mortality of 7%. Twenty-four patients (92% of survivors) adhered to the follow-up protocol (mean 37.3±17.5 months), and they are all alive without instances of reintervention.

In our experience, endovascular treatment of acute traumatic thoracic aortic injuries using different commercially available stent-grafts allows to obtain satisfactory short term results.