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Thoracic aorta emergencies: is the endovascular treatment the new gold standard?

Department of Cardiovascular Surgery, Centre Hôpitalier Universitaire Vaudois (CHUV), 46 Rue du Bugnon, CH-1011, Lausanne, Switzerland

*Corresponding author. Tel.: +41 79 310 1386; fax: +41 21 314 2278.

E-mail address: enrico.ferrari{at}chuv.ch (E. Ferrari).

Background: The endovascular treatment for acute traumatic aorta rupture has been proven to be safe in emergency. Technical aspects concerning the device fixation, the materials' durability, and the patients' selection criteria are still under discussion. We present our clinical experience and the mid-term follow-up. Methods: Between January 2001 and January 2005, twenty-five patients have been diagnosed with acute traumatic aorta wall rupture in our emergency department. An angio computed tomography scan (CT-scan) was performed to confirm the diagnosis and to localize the aortic lesions. Eighteen patients with isolated intimal lesion, aorta wall hematoma or aorta wall tear up to 1/3 of the circumference, received the endovascular treatment. The intravascular ultrasound (IVUS) and the fluoroscopy control were used routinely. The procedure was considered to have succeeded in the case of complete aortic wall tear occlusion. A CT-scan follow-up was organized 1 week and 1 year after the procedure. Results: Eighteen patients underwent endovascular treatment and 17 of these patients presented associated multiple injuries. The mean age was 40.7±12 years. The hospital mortality rate was 0%. In one patient the distal part of the graft was accidentally deployed into the brachiocephalic trunk and was surgically removed 8 weeks later. Two patients (11.1%) suffered from transitory neurological disturbances and 4 patients (22.2%) had the left subclavian artery ostia occluded by the graft, without developing symptoms. The mean follow-up time was 21±3 months: 1 patient (5.5%) died 1 month after the procedure for acute aortic rupture and no endoleaks were reported. Conclusions: The endovascular treatment for traumatic aortic rupture is an interesting alternative to conventional open surgery for a selected patient cohort. The stent graft material and the fixation to the normal aortic wall are safe and reliable in the mid-term. The results lead us to choose this approach as the treatment of choice in selected patients with traumatic aortic wall rupture.

Key Words: Aortic rupture; Thoracic aorta; Vascular endoprosthesis; Intravascular ultrasound (IVUS)