Endovascular stent-grafting for traumatic aortic aneurysms with the use of a fenestrated stent-graft

Endovascular treatment of traumatic rupture of the thoracic aorta

Background

Traumatic rupture of the thoracic aorta is a life-threatening event. Open surgical repair is the ‘gold standard’, but is associated with high mortality and morbidity rates. Endovascular repair is emerging as a potentially safer alternative.

Methods

A systematic review was performed of all published literature on this subject, including the authors' own experience. Using Sumsearch, PubMed and cross-references, all published reports up to January 2006 were identified, and analysed for injuries, perioperative morbidity, mortality, operating time, hospital stay and follow-up.

Results

A total of 284 patients were identified. Reported mortality rates range from 0 to 6 per cent. The procedure-related mortality rate is about 1·5 per cent. Some 6·7 per cent of all procedures were complicated by endoleak and the overall procedure-related morbidity rate was 14·4 per cent. These results are promising compared with those of open repair, but individual experience is limited and there may be some publication bias.

Conclusion

Endovascular repair of traumatic rupture of the thoracic aorta seems to reduce morbidity and mortality in patients with multiple trauma. Ideally, both devices and experienced personnel should be available in trauma centres.

Endovascular Stent-Graft Treatment for Blunt Aortic Injury

BACKGROUND

Thoracic aortic injury resulting from blunt trauma is usually fatal and almost always associated with multiple, complex, nonaortic injuries that can adversely affect standard surgical repair of the aorta. Endovascular stent - graft treatment offers these patients a less invasive operative treatment option.

METHODS AND RESULTS

Between January 2002 and October 2003, 6 patients with blunt aortic injury (BAI) were treated with a stent - graft. In all cases endovascular management was selected because of associated polytrauma or comorbidities. All stent - grafts were homemade and deployed through the femoral artery with 18-20 Fr delivery sheaths. There were no cases of perioperative death, renal failure, or neurologic complication. In one patient the postoperative computed tomography scan showed proximal endoleak requiring additional balloon dilatation and stenting. No other endoleaks were observed by CT in the acute phase. None of the follow-up CT scans revealed evidence of endoleak, migration, or alteration of the stent - graft.

CONCLUSIONS

Endovascular repair for BAI is technically feasible and is an alternative to open surgery for high-risk patients.

Urgent thoracic aortal dissection and aneurysm: treatment with stent-graft implantation in an angiographic suite

The aim of this study was to evaluate the feasibility of endoluminal stent-graft placement in an angiographic suite for the treatment of emergent type-B aortic dissections and ruptured thoracic aortal aneurysms. Twenty-six patients with either urgent type-B dissection (n=8) or aneurysms (n=18) of the descending thoracic aorta were chosen for stent-graft implantation. All patients received a multidetector-row CT angiography of the whole aorta and pelvic arteries prior to stent-graft implantation. All procedures were performed in a fully equipped digital subtraction angiography (DSA) suite under general anesthesia. In 20 patients Talent LPS tube grafts and in 4 patients an Excluder graft were used. Access was achieved via surgical cut-down in the left (n=7) or right (n=19) groin. Sealing was successful in 24 patients. The proximal covered portion of the stent graft was placed across the left subclavian artery in 2 patients. Procedural success was achieved in 23 of 24 patients. One patient required a second stent-graft placement before the aneurysm was sealed. One patient with an acute perforation of the descending aorta died due to cardiac failure prior to stent-graft implantation. In 1 patient stent-graft delivery failed due to severe calcification of both common iliac arteries. Endoluminal treatment of both urgent type-B aortic dissections and thoracic aortal aneurysms with stent graft is an attractive alternative treatment to surgical repair. The placement of stent grafts in an angiographic suite is a safe and feasible method with good clinical effectiveness and, so far, good clinical outcome.