Article ID Journal Published Year Pages File Type
3026572 Seminars in Vascular Surgery 2006 12 Pages PDF
Abstract

Acute traumatic aortic tear (ATAT) is the second most common cause of deaths in trauma patients (about 8,000 deaths/year in the USA). Due to circumferential aortic disruption, up to 90% die at the scene. Responsible trauma mechanisms are: penetrating (gunshot/stab wounds), iatrogenic (interventional catheterization) and, most frequently, blunt chest trauma (high-speed motor vehicles, falls from heights, crushes, explosions) resulting in injury at the aortic isthmus region (loco typico, about 90%). Severe multiple system injuries (polytrauma), especially to intracranial and intraabdominal organs, are characteristic and prognostically predicitive. Immediate transthoracic open repair of ATAT has a mortality risk of 8% to 33% and paraplegia risk of 2% to 26%. Contrast enhanced CT scan has replaced the classical angiography as the diagnostic tool of choice. Patients with life-threatening multisystem injuries are scheduled for delayed repair after initial stabilization. Currently, the use of endovascular stent-grafts (EVAR) is being investigated. Our personal series confirms that EVAR for ATAT is a viable alternative to open repair while minimizing the morbidity and mortality of the open procedure and having a limited impact on trauma destabilization. The assessment of long-term durability of EVAR is one of the key issues to consider EVAR as the first choice of treatment.

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