Print this page15 Consecutive Cases of Endograft Repair of Traumatic Aortic Disruption: Lessons Learned
Rao Gutta MD, Kirk Charles MD, Bartley P. Griffith MD, Sina Moaine MD, Thomas M. Scalea MD, William R. Flinn MD and David G. Neschis MD
University of Maryland, Baltimore, MD
Objective(s):
Endograft repair holds considerable promise in the treatment of traumatic disruption of the thoracic aorta as patients often have multiple coexisting injuries further complicating traditional open repair. Additionally, patients are often young, with aortic anatomy dissimilar to those with atherosclerotic aneurysms. As a result, techniques for endograft repair have to be refined accordingly.
Methods:
The records of 15 consecutive cases of traumatic aortic disruption treated by endograft repair at a single institution were reviewed.
Results:
Patient age ranged from 17-95 with a mean age of 43 years. 12/15 patients (80%) were male. Technical success was 13/15 (87%). There were no procedural related deaths. 5/15 patients (33%) died of their co-existing injuries, usually severe head trauma. Only 2/15 cases (13%) required a graft larger than 28mm in diameter. 4/15 aortas (27%) were small enough to require use of 23mm abdominal cuffs. 6/15 cases (40%) required complete or partial coverage of the left subclavian artery. There was a single case of type one endoleak requiring placement of a proximal extension. One case resulted in graft collapse requiring surgical removal and aortic repair.
Conclusions:
Endovascular repair of traumatic aortic disruption can be accomplished in the majority of cases. As compared to atherosclerotic aneurysms, the proximal thoracic aorta tends to be smaller and the arch angle tighter. This frequently necessitates the use of smaller devices and less stiff wires. Surgeons should be prepared to cover the left subclavian artery if needed, have a wide range of device sizes in stock to avoid oversizing, and show restraint if anatomy appears unsuitable.