Endovascular Treatment (EVT) of Acute Traumatic Lesions of the Descending Thoracic Aorta – 7 Years' Experience

Objectives

To present a single centers' 7-year experience in the endovascular treatment of acute traumatic lesions of the descending thoracic aorta (ATL of the DTA).

Materials & methods

Between March 1999 and December 2006, 34 consecutive acute traumatic lesions of the descending aorta (23 men, mean age 44 years) were treated endovascularly. Stentgrafts used were TAG Excluder, Zenith TX2 and Talent. In 23 patients the Left Subclavian Artery (LSA) was covered. Mean procedural duration was 20 to 75 minutes.

Results

Exclusion of the rupture site was achieved in all cases with no conversion to open surgery. Overall 30-day mortality was 8.8%. Two patients died on post operative day (pod) 1 and one on pod 22 from cranial injuries. No death or neurological deficit related to the endovascular treatment was reported. Four type I endoleaks required treatment either by balloon reexpansion (n=2) or by additional stentgraft implantation (n=2). In two patients the stentgraft collapsed totally several days postoperatively. Two patients required secondary surgical procedures (iliac access complication and revascularisation of the left subclavian artery n=1). The average follow-up was 43.8 months (1–93 months). No stentgraft related abnormality has been subsequently documented.

Conclusions

The endovascular treatment of ATL of the DTA may offer the best means of therapy in a polytrauma patient.

Keywords: Endovascular, Traumatic, Thoracic aorta, Stentgraft, Transection