This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Carlos A. Mestres Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mestres, C. A. Search for Related Content PubMed PubMed Citation Articles by Mestres, C. A. Related Collections Related Article

The treatment of traumatic disruption of the thoracic aorta

Department of Cardiovascular Surgery, Hospital Clínico, University of Barcelona, Barcelona 08036, Spain

Endovascular management of a thoracic aortic disruption following failure of deployment of a parachute

The authors have to be commended for the final result and immediate follow-up data with exclusion of the transected area [1]. In this case the only interesting point is the cause of blunt chest trauma which is really uncommon as not everybody parachutes. The remaining aspects of the case are not really new. The most important influencing factor in the case of traumatic disruption of the thoracic aorta is the associated comorbidity in the form of multiple lesions. Other than that the results for open surgery with no critical comorbidity have also been good for decades. The advent of endovascular stenting in these cases has facilitated further management on a delayed basis. There is only a question in this case which relates to why an immediate postoperative transfer to another institution. Experience shows that if the patient does not die at the scene, the chances of survival are pretty high. An interinstitutional transfer immediately after thoracolaparotomy might eventually be harmful for such patients, even in the best hands and conditions. In the past five years, over a dozen patients have undergone endovascular repair for traumatic aortic transection on a delayed basis at our Institution, a few days after admission once their conditions were stabilized and patient viability was carefully assessed, especially in the cases of associated brain trauma with low GCS. Open repair has also been performed before and during the era of endovascular practice and a few more patients underwent stenting years after blunt chest trauma when false aneurysms were incidentally discovered. The ultimate message should always be the same; first, repair of the most severe lesions as the condition of the patient is most likely to be critical and not related to the aorta; second, assess neurological viability; third, proceed with delayed aortic repair if the clinical status allows for it.

I would like to congratulate our colleagues for the final successful outcome of the case. It is a pity that they still have to work on an investigational basis. The long-term fate of stent-grafts in very young patients with small aortas are still a matter of concern.

	Reference

Top Reference

 

1. Kpodonu J, Wheatley GH III, Ramaiah VG, Diethrich EB. Endovascular management of a thoracic aortic disruption following failure of deployment of a parachute. Interact CardioVasc Thorac Surg 2007; 6:823–825.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Carlos A. Mestres Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mestres, C. A. Search for Related Content PubMed PubMed Citation Articles by Mestres, C. A. Related Collections Related Article