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Ann Thorac Surg 2006;82:873-878
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Endovascular Repair of Thoracic Aortic Tears

^a Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
^b Division of Vascular Surgery, Northwestern Memorial Hospital, Chicago, Illinois
^c Department of Cardiothoracic, Surgery Mt. Sinai Medical Center, New York, New York

Accepted for publication April 3, 2006.

^_* Address correspondence to Dr Tehrani, University of Miami/Jackson Memorial Hospital, Department of Surgery, 1611 NW. 12th Ave., ET 3016, Miami, FL 33136 (Email: htehrani{at}med.miami.edu).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: Standard treatment of traumatic thoracic aortic transection (TTAT) is open repair by left thoracotomy with or without the use of partial cardiopulmonary bypass. However, open repair is associated with high rates of morbidity and mortality, particularly in multiply injured trauma patients. We reviewed our experiences of endovascular repair of acute TTAT.

METHODS: Between February 2001 and February 2006, 30 patients (male 24, female 6, mean age 43 years) who had sustained severe blunt trauma with multiple injuries (mean injury severity score = 42) underwent endovascular repair for TTAT. Devices used included commercially available proximal abdominal aortic extension cuffs and thoracic stent-grafts. Either low dose or no systemic heparin was used. Arterial access was obtained by femoral-iliac cutdown (n = 19) or completely percutaneous through the femoral artery (n = 11). Mean follow-up was 11.6 months (range, 1 to 48 months).

RESULTS: Technically success was achieved in 100% of patients, as determined by angiographic and computed tomographic (CT) scan exclusion of TTAT. Mean operating time was 132 minutes. Mean blood loss was 300 cm³. Three patients had complications: 1 iliac artery rupture, 1 cerebellar stroke, and 1 partial stent collapse. There were 2 perioperative deaths. There were no instances of procedure-related paralysis. Clinical and CT follow-up did not reveal evidence of endoleak, stent migration, or late pseudoaneurysm formation.

CONCLUSIONS: The adaptation of commercially available stent-graft devices to treat TTAT is technically feasible, and can be performed with low rates of morbidity and mortality. The long-term durability of endovascular repair of TTAT remains unknown, but early and midterm results appear promising.

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