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BACKGROUND
The endovascular repair of traumatic aortic rupture has been proven to be safe and consistent, but still many questions are open concerning the durability of the stent-graft material, device fixation and aortic wall remodelling. We present our experience.
METHODS
Twenty-five patients with traumatic aortic rupture at the CTscan were admitted and those with isolate intimal lesion, aortic wall hematoma and rupture involving 1/3 of the aortic diameter received endovascular treatment. Prosthesis was deployed under IVUS and fluoroscopy control. Procedure succeeded if occlusion of thoracic tears and absence of endoleaks were achieved. Patients were followed-up with CTscan at 1week, 6 months and 1 year.
RESULTS
18 patients received endovascular treatment. Mean age was 40.7years. Mean follow-up was 21±3 months; 1 patient died 1 month later (5.5%) for aortic rupture. One patient had the graft deployed into the brachio-cephalic trunk and it was removed 8 weeks after. No infection was observed; 2 patients (11.1%) suffered of diffuse cerebral embolism; subclavian artery was occluded in 4 patients (22.2%), none received subclavian artery revascularization; 8 patients (44%) had biological inflammatory syndrome for 1 to 5 days after the procedure. Pseudoaneurysm of the endoprosthesis was observed in 3 patients (17.6%).
CONCLUSIONS
Emergency endovascular repair of the aortic traumatic rupture is a valid alternative to open surgery to treat isolated intimal lesion, aortic wall haematoma and aortic rupture involving less than 1/3 of the aortic diameter with or without aortic dissection. Graft “pseudoaneurysm” is probably due to the aortic remodelling and doesn’t need surgical correction.