Long-term results following emergency stent graft repair for traumatic rupture of the aortic isthmus

Eur J Cardiothorac Surg. 2017 Apr 1;51(4):767-772. doi: 10.1093/ejcts/ezw369.

Abstract

Objectives: Endovascular repair of traumatic injury of the aortic isthmus is a safe technique that has shown good short-term results. However, the future of these stent grafts remains unexamined, especially in relation to young patients.

Methods: Between January 2000 and December 2014, 60 patients were treated with endovascular aortic stent graft for injury of the aortic isthmus. Follow-up was done by computed tomography scans with intravenous contrast or magnetic resonance imaging associated with a chest X-ray in order to control the stent graft.

Results: In total, 48 men (80%) were included; the average age was 43 ± 17 years [17; 79]. The median time between the accident and endovascular repair was 6 h. Endovascular repair was successful in all cases with no cerebrovascular or paraplegia after treatment. Seventeen patients (27.3%) received a total coverage of the left subclavian artery; one of them received a subclavian carotid bypass. Mean follow-up was 5 years with a maximum of 14 years. There was no repeat surgery related to the aorta during follow-up. No stent graft failure, neurological or ischaemic event related to the stent graft was noted. One patient had a type 1 endoleak without any reintervention. The survival rate was 86.5% in 1 year, 81.6% in 5 years and 75.3% in 10 years.

Conclusions: Treatment of injuries of the aortic isthmus with stent graft seems to be a safe long-term technique; we did not notice any event related to the stent graft during the follow-up.

Keywords: Aorta; Blunt; Endovascular procedure; Outcomes; Trauma.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / injuries*
  • Aorta, Thoracic / surgery
  • Aortic Rupture / diagnostic imaging
  • Aortic Rupture / etiology
  • Aortic Rupture / surgery*
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation / methods*
  • Emergencies
  • Endovascular Procedures / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Wounds, Nonpenetrating / diagnostic imaging
  • Wounds, Nonpenetrating / etiology
  • Wounds, Nonpenetrating / surgery
  • Young Adult