Traumatic Thoracic Aorta Rupture Treated by Stentgraft Implantation
Novotný J.1, Peregrin J. H.1, Pirk J.2
ZRIR, Institut klinické a experimentální medicíny, Praha1 přednosta doc. MUDr. J. H. Peregrin, CSc. KKCH, Institut klinické a experimentální medicíny, Praha2 přednosta prof. MUDr. J. Pirk, DrSc. |
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Summary:
Introduction: A method of traumatic thoracic aorta rupture treated by stentgraft
implantation is reported. The results of last three years procedures are analyzed.
Mechanism of aortic trauma and diagnosis algorithm is described.
Materials and methods: The most important imaging methods in diagnosis of thoracic
aorta trauma are spiral CT and transoesophageal echocardiography. Both types of
investigation enable calibration of the aortic dimensions for stentgraft size selection.
Endovascular procedure is performed either in general or spinal anesthesia using
femoral artery cut-down approach. Thoracic aorta stentgraft is of tubular shape. The
stentgraft is constructed from metal body and textile cover (Dacron, ePTFE). In all
cases of our series a Talent stentgraft (Medtronic, Sunnyvale, CA) was used.
Group consisted of 12 patients with traumatic aortic rupture: eleven males and one
female, average age was 49.2 years. Acute rupture was treated in seven cases, chronic
rupture – pseudoaneurysm was treated in five cases.
Results: The stentgraft was implanted to the area of aortic isthmus in all cases; four
times authors had to implant the stentgraft over the origin of the left subclavian artery.
In one case the patient has constructed subclavio-carotico-subclavian bypass prior
the procedure as it was necessary to occlude left carotid artery during stentgraft
implantation. Primary technical success (complete exclusion of the transsection or
aneurysm from the circulation) was achieved in 10 out of 20 patients. Two patients presented
with endoleak immediately after procedure: One of them with multiple concomitant
traumatic injuries died two days after procedure from non-circulatory reasons.
In the other patient endoleak (pseudoaneurysm) disappeared within one month after
the procedure, but two years later the endoleak reappeared after thrombolytic theraradiologie given to the patient in other hospital during treatment of DVT.
Conclusion: Authors consider the treatment of the traumatic aortic rupture by stentgraft
implantation as a method of choice.
Key words:
thoracic aorta – aneuryzm – stentgraft – stent – rupture
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