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J Thorac Cardiovasc Surg 2006;132:1037-1041
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Endovascular repair of traumatic rupture of the aortic isthmus: Midterm results

^a Department of Thoracic and Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France
^b Department of Radiology, Rangueil University Hospital, Toulouse, France
^c Department of Epidemiology and Biostatistics, University Hospital, Toulouse, France
^d Department of Cardiology, Montauban General Hospital, Montauban, France.

^_* Address for reprints: Hervé Rousseau, MD, Radiology Department, Rangueil University Hospital, TSA 50032, 1 avenue Jean Poulhès, 31059 Toulouse, Cedex 9, France. (Email: rousseau.h{at}chu-toulouse.fr).

OBJECTIVE: The endovascular management of aortic traumatic ruptures has been proposed as an alternative to classical surgical procedures. The aim of this work was to report the midterm results of the endovascular treatment of traumatic ruptures of the isthmic aorta.

METHODS: Between January 1996 and July 2005, endovascular repair of blunt traumatic aortic ruptures was performed in 33 patients (mean age, 40 ± 17 years). The stent grafts used were either Talent Medtronic (n = 27), Gore Excluder (n = 4), or Boston Vanguard (n = 2) grafts. Follow-up was 94.9% complete and averaged 32.4 ± 28.8 months (maximum, 8 years).

RESULTS: Stent graft deployment was successful in all cases without need for surgical conversion. Except for one iliac rupture, which was treated with an iliofemoral bypass during the same procedure, there was no major perioperative complication. The early complications consisted of 3 primary endoleaks (1 type I and 2 type IV), 1 transient paraparesis, 1 occlusion of the main left bronchus, 1 thrombosis, and 2 pseudoaneurysms of the brachial artery. All the primary endoleaks healed within the first month. No patient died, and no aortic reinterventions were performed. The midterm complications were a mild circumferential thrombus at the distal part of the stent graft and a fracture of the nitinol stent. Both complications were asymptomatic and were discovered on systematic computed tomographic scan examination. Actuarial freedom from complication at 1 year was 96.1% ± 3.8% and 85.5% ± 10.6% at 3 and 5 years, respectively.

CONCLUSION: This study demonstrates that the endovascular treatment of blunt thoracic aortic traumatisms is a safe and effective therapeutic method without increased midterm morbidity and mortality rates.

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