Endovascular repair of traumatic thoracic aortic rupture: a single centre experience

Background: Thoracic aortic rupture is usually the result of a sudden deceleration caused by a traffic accident, fall or some other misfortune. Before the endovascular era, there was only one treatment option: open repair, burdened by high morbidity and significant mortality. Now, we have the ability to treat it with a stent graft. The advantages of this method include avoiding a thoracotomy or aorta cross-clamping and their associated complications. Aim: To present our experience and results of endovascular treatment of thoracic aortic ruptures. Methods: Since 1998, we have performed endovascular treatment for aortic lesions in 1,598 patients. From this group, the indication for stent graft implantation in 31 patients was a traumatic aortic rupture or pseudoaneurysm caused by an injury. All patients had a history of blunt chest trauma. The sequence of injury treatment depended on the severity of each. In all but two patients, the first was an aortic stent graft implantation. The length of thoracic aorta covered ranged from 100–200 mm (mean 123 mm). We did not use any method of spinal cord ischaemia protection. Final angiography showed complete exclusion of the aortic disruption in all patients. Results: All but one operation was successful. One patient died intraoperatively due to concomitant injuries. After the operation, none of the patients had signs of spinal cord ischaemia or any other complications through a follow-up period ranging from 12 to 96 months (mean 40 months). Conclusions: Our experience with traumatic thoracic aortic ruptures suggests that endovascular treatment should be the method of choice, especially in unstable multi-trauma patients. However, long-term studies are required to assess the durability of this technique after many years.