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Original Articles: Adult Cardiac

Curved Nitinol Stent-Graft Placement for Treating Blunt Thoracic Aortic Injury: An Early Experience

^a Department of Radiology, Kobe Red Cross Hospital/Hyogo Emergency Medical Center, Kobe, Japan
^b Department of Cardiovascular Surgery, Kobe Red Cross Hospital/Hyogo Emergency Medical Center, Kobe, Japan
^c Department of Emergency, Kobe Red Cross Hospital/Hyogo Emergency Medical Center, Kobe, Japan
^d Department of Radiology, Kobe University Hospital, Kobe, Japan
^f Department of Cardiovascular Surgery, Kobe University Hospital, Kobe, Japan
^e Division of Vascular and Endovascular Surgery, University Hospitals Case Medical Center, Cleveland, Ohio

Accepted for publication May 15, 2008.

^_* Address correspondence to Dr Yamaguchi, Department of Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan (Email: masato03310402{at}yahoo.co.jp).

Background: Blunt trauma-induced aortic injury traditionally has been treated with early open surgical repair. However, recently endovascular stent-graft technology is considered a less-invasive therapeutic alternative, and flexible stent-grafts, such as the Matsui-Kitamura stent-graft (MKSG), are being used widely. We report our experience with the curved MKSG in treating thoracic aortic injuries.

Methods: Nine patients with traumatic thoracic aortic injury underwent endovascular surgery (8, emergency; 1, elective) with curved MKSG. The study variables were Injury Severity Score, endovascular surgery duration, aortic and stent-graft diameter, stay in the intensive care unit, follow-up period, and mortality. An MKSG was constructed using the Matsui-Kitamura stent and a polyester fabric graft. The stent-graft was placed using the transfemoral approach and the wire-tug technique.

Results: The mean Injury Severity Score was 42.3; 5 patients required 6 emergency procedures before the endovascular procedure (pneumothorax or hemothorax drainage, 5; transarterial embolization, 1). In 8 patients (88.9%), we achieved complete pseudoaneurysm exclusion or hemostasis in the injured portion. There were no postoperative complications; blood loss was minimal, and the intensive care unit stay was 13.4 days. The overall hospital mortality was 22.2% (n = 2; causes of death were unrelated to MKSG placement). Neither intervention-related mortality during follow-up (mean, 237.7 days) nor late endovascular graft-related complications (endoleak or graft migration) were noted.

Conclusions: Although this study is limited by a small sample size and short follow-up period, no collapse or stent-graft fractures were noted. Thus, MKSG placement for traumatic thoracic aortic injury appears a safe and effective therapy.

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Invited Commentary

Sina L. Moainie and Bartley P. Griffith
Ann. Thorac. Surg. 2008 86: 786. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				S. L. Moainie and B. P. Griffith Invited Commentary Ann. Thorac. Surg., September 1, 2008; 86(3): 786 - 786. [Full Text] [PDF]