BACKGROUND:
High mortality and paraplegia rates associated with the surgical management of acute thoracic aortic ruptures, limit its success. It was our objective to evaluate whether emergency endovascular interventions, in these patients, would improve their outcome.
METHODS:
60 patients, age 28 to 83 years, were admitted to or institution with an acute rupture of the thoracic aorta (27 ruptured aneurysms, 15 perforated type B dissections, 18 traumatic ruptures). 28 patients were managed surgically utilizing cardiopulmonary bypass and 32 patients were acutely treated with an endovascular stent graft. Medical records were reviewed for pre-hospital and emergency department data, operative findings and outcomes. Patients were followed up in yearly intervals with high resolution multidetector computerd tomography angiography.
RESULTS:
Perioperatively there were 1/32 deaths (3.1%) in the endovascular group and 5/28 deaths (17.8%) in the surgical group. There were four late deaths in the endovascular group and one in the surgical group. There were 2 access failures in the endovascular group. There was one stroke in the endovascular group and one case of paraplegia in the surgical group. Three patients developed endoleaks in the endovascular group and required reintervention. Two patients in the endovascular group developed late thrombosis of the left subclavian artery.
CONCLUSIONS:
Despite encouraging early outcomes, midterm results suggest a trend towards increased reintervention and late complication rates, in the endovascular group. Therefore, continued surveillance of patients treated with stent grafts is necessary.

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