Endovascular repair of traumatic aortic isthmic rupture: Early and mid-term results

• Published in: Journal de médecine vasculaire Vol. 45; no. 5; pp. 254 - 259
• Main Authors: Ben Hammamia, M., Ben Mrad, M., Ziadi, J., Derbel, B., Miri, R., Ben Abdelaziz, E., Daoud, Z., Krarti, N., Koubaa, M.A., Tarzi, M., Khadhar, Y., Lagha, A., Ghedira, F., Ben Omrane, S., Kalfat, T., Bounawes, I., Denguir, R.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01-09-2020
• Subjects: Aortic rupture; Thoracic endovascular aortic repair; Thoracic endovascular aortic repair; Aortic rupture
• ISSN: 2542-4513
• DOI: 10.1016/j.jdmv.2020.06.007

Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture.
This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture.
Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14–66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18–36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5–96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported.
TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.