Endovascular repair of acute traumatic injury of thoracic aorta

Blunt thoracic aortic injury is associated with a high mortality rate. It is the second leading cause of death after head injury from vehicle accidents. Surgical repair with graft interposition was the traditional treatment of blunt aortic injury however; the introduction of endovascular stent graft has revolutionized the definitive treatment of these injuries.ObjectivesTo review our experience with endovascular repair (EVR) of acute traumatic injury to thoracic aorta regarding technique, device, complications and outcome.Patients and methodsThis series included 14 patients subjected to EVR for acute traumatic aortic injury (ATAI) to the thoracic aorta between January 2010 and August 2011. The diagnosis was suspected in 11 patients based on plain X-ray and the mechanism of trauma and was confirmed on CT scan. The other 3 cases were diagnosed incidentally during CT scan for other indications. Gore TAG device was used in all patients.ResultsEVR was well tolerated with no peri-procedural mortality, conversion to open surgery, post-intervention paraplegia or significant blood loss. Complications encountered are: inadvertent stent jump (1), endoleak type 1 (1), endoleak type 3 (1), and left common iliac artery thrombosis (1).ConclusionEndovascular repair of acute traumatic injury to thoracic aorta can be performed with less risk than emergency surgical treatment. It is a less invasive therapeutic option even in young and low risk patients. It can be performed rapidly with minimal blood loss and subsequent shorter convalescent periods.