PDF herunterladen
CC BY 4.0 · Aorta (Stamford) 2013; 01(02): 117-122
DOI: 10.12945/j.aorta.2013.12-009
State-of-the-Art Review
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acute Traumatic Thoracic Aortic Injury

Considerations and Reflections on the Endovascular Aneurysm Repair
Luca Di Marco
1   Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
,
Davide Pacini
1   Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
,
Roberto Di Bartolomeo
1   Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
› Institutsangaben
Weitere Informationen

Publikationsverlauf

20. November 2012

13. Mai 2013

Publikationsdatum:
28. September 2018 (online)

   Lizenzen und Reprints

Abstract

Traumatic rupture of the thoracic aorta is a life-threatening lesion and it occurs in 10 to 30% of fatalities from blunt thoracic trauma and is the second most common cause of death after head injury. Immediate surgery is often characterized by a high mortality and morbidity rate. Delayed repair of traumatic aortic injuries has significant survival benefits and a much lower mortality rate compared with early open repair. Despite developments in operative techniques, there still remains considerable operative mortality and morbidity associated with a surgical approach even if delayed. Endovascular stent grafts for the thoracic aorta represents an alternative to the conventional approach for traumatic aortic rupture. Because of the lower invasivity avoiding thoracotomy and use of heparin, endovascular repair can be applied in acute patients without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. However, despite the good deal of convincing evidence for endovascular treatment for thoracic aortic diseases and for traumatic aortic injuries as a valid and efficacious alternative to surgery, several reports show a variety of late complications of thoracic endografts especially for first-generation stent-grafts. In light of this, is the endovascular treatment really safe, efficacious and free from complications in the long term? This manuscript aims to offer a moment of reflection on this important chapter of aortic pathology.

Key Words

Aortic - Traumatic - Endovascular - Acute injury
 

  • References

  • 1 Richens D, Kotidis K, Neale M, Oakley C, Fails A. Rupture of the aorta following road traffic accidents in the United Kingdom 1992-1999. The results of the co-operative crash injury study. Eur J Cardio-Thoracic Surg 2003; 23: 143-148 . 10.1016/S1010-7940(02)00720-0
    CrossrefPubMedGoogle Scholar
  • 2 Bertrand S, Cuny S, Petit P, Trosseille X, Page Y, Guillemot H. , et al. Traumatic rupture of thoracic aorta in real-world motor vehicle crashes. Traffic Inj Prev 2008; 9: 153-161 . 10.1080/15389580701775777
    CrossrefPubMedGoogle Scholar
  • 3 Attar S, Cardarelli MG, Downing SW, Rodriguez A, Wallace DC, West RS. , et al. Traumatic aortic rupture: recent outcome with regard to neurologic deficit. Ann Thorac Surg 1999; 67: 959-964 . 10.1016/S0003-4975(99)00174-5
    CrossrefPubMedGoogle Scholar
  • 4 Von Oppell UO, Dunne TT, De Groot MK, Zilla P. Traumatic aortic rupture: twenty-year metaanalysis of mortality and risk of paraplegia. Ann Thorac Surg 1994; 58: 585-593 . 10.1016/0003-4975(94)92270-5
    CrossrefPubMedGoogle Scholar
  • 5 Fattori R, Russo V, Lovato L, Di Bartolomeo R. Optimal management of traumatic aortic injury. Eur J Vasc Endovasc Surg 2009; 37: 8-14 . 10.1016/j.ejvs.2008.09.024
    CrossrefPubMedGoogle Scholar
  • 6 Strassman G. Traumatic rupture of the aorta. Am Heart J 1947; 33: 508-515 . 10.1016/0002-8703(47)90098-7
    CrossrefPubMedGoogle Scholar
  • 7 Hunt JP, Baker CC, Lentz CW, Rutledge RR, Oller DW, Flowe KM. , et al. Thoracic aorta injuries: management and outcome of 144 patients. J Trauma 1996; 40: 547-555 ; discussion 555–556. 10.1097/00005373-199604000-00005
    CrossrefPubMedGoogle Scholar
  • 8 Fabian TC, Richardson JD, Croce MA, Smith Jr JS, Rodman Jr G, Kearney PA. , et al. Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma. J Trauma 1997; 42: 374-380 ; discussion 380–383.
    CrossrefPubMedGoogle Scholar
  • 9 Akins CW, Buckely MJ, Daggett W, McIlduff JB, Austen WG. Acute traumatic disruption of the thoracic aorta: a ten-year experience. Ann Thorac Surg 1981; 31: 305-309 . 10.1016/S0003-4975(10)60955-1
    CrossrefPubMedGoogle Scholar
  • 10 Galli R, Pacini D, Di Bartolomeo R, Fattori R, Turinetto B, Grillone G. , et al. Surgical indications and timing of repair of traumatic ruptures of the thoracic aorta. Ann Thorac Surg 1998; 65: 461-464 . 10.1016/S0003-4975(97)01302-7
    CrossrefPubMedGoogle Scholar
  • 11 Demetriades D, Velmahos GC, Scalea TM, Jurkovich GJ, Karmy-Jones R, Teixeira PG. , et al. Blunt traumatic thoracic aortic injuries: early or delayed repair–Results of an American Association for the Surgery of Trauma prospective study. J Trauma 2009; 66: 967-973 . 10.1097/TA.0b013e31817dc483
    CrossrefPubMedGoogle Scholar
  • 12 Pacini D, Angeli E, Fattori R, Lovato L, Rocchi G, Di Marco L. , et al. Traumatic rupture of the thoracic aorta: ten years of delayed management. J Thorac Cardiovasc Surg 2005; 129: 880-884 . 10.1016/j.jtcvs.2004.10.012
    CrossrefPubMedGoogle Scholar
  • 13 Appoo JJ, Moser WG, Fairman RM, Cornelius KF, Pochettino A, Woo EY. , et al. Thoracic aortic stent-grafting: improving results with newer generation investigational devices. J Thorac Cardiovasc Surg 2006; 131: 1087-1094 . 10.1016/j.jtcvs.2005.12.058
    CrossrefPubMedGoogle Scholar
  • 14 Xenos ES, Abedi NN, Davenport DL, Minion DJ, Hamdallah O, Sorial EE. , et al. Meta-analysis of endovascular versus open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 2008; 48: 1343-1351 . 10.1016/j.jvs.2008.04.060
    CrossrefPubMedGoogle Scholar
  • 15 Demetriades D, Velmahos GC, Scalea TM, Jurkovich GJ, Karmy-Jones R, Teixeira PG. , et al. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma Multicenter Study. J Trauma 2008; 64: 561-571 . 10.1097/TA.0b013e3181641bb3
    CrossrefPubMedGoogle Scholar
  • 16 Pate JW, Fabian TC, Walker W. Traumatic rupture of the aortic isthmus: an emergency?. World J Surg 1995; 19: 119-125 ; discussion 125–126.
    CrossrefPubMedGoogle Scholar
  • 17 Feezor RJ, Lee WA. Management of the left subclavian artery during TEVAR. Semin Vasc Surg 2009; 22: 159-164 . 10.1053/j.semvascsurg.2009.07.007
    CrossrefPubMedGoogle Scholar
  • 18 Cooper DG, Walsh SR, Sadat U, Noorani A, Hayes PD, Boyle JR. Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: a systematic review and meta-analysis. J Vasc Surg 2009; 49: 1594-1601 . 10.1016/j.jvs.2008.12.075
    CrossrefPubMedGoogle Scholar
  • 19 Steinberg GK, Drake CG, Peerless SJ. Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients. J Neurosurg 1993; 79: 161-173 . 10.3171/jns.1993.79.2.0161
    CrossrefPubMedGoogle Scholar
  • 20 Sepehripour AH, Ahmed K, Vect JA, Anagnostakou V, Suliman A, Ashrafian H. , et al. Management of the left subclavian artery during endovascular stent grafting for traumatic aortic injury–A systematic review. Eur J Vasc Endovasc Surg 2011; 41: 758-769 . 10.1016/j.ejvs.2011.01.007
    CrossrefPubMedGoogle Scholar
  • 21 Kasirajan K, Milner R, Chaikof EL. Late complications of thoracic endografts. J Vasc Surg 2006; 43: 94A-99A 10.1016/j.jvs.2005.10.064
    CrossrefPubMedGoogle Scholar
  • 22 Nienaber CA, Kische S, Ince H. Thoracic aortic stent-graft devices: problems, failure modes, and applicability. Semin Vasc Surg 2007; 20: 81-89 . 10.1053/j.semvascsurg.2007.04.005
    CrossrefPubMedGoogle Scholar
  • 23 Umscheid T, Stelter WJ. Time-related alterations in shape, position, and structure of self-expanding, modular aortic stent-grafts: a 4-year single-center follow-up. J Endovasc Surg 1999; 6: 17-32
    CrossrefPubMedGoogle Scholar
  • 24 Annamalai G, Cook R, Martin M. Endograft collapse following endovascular repair of traumatic aortic injury. Diagn Interv Radiol 2011; 17: 84-87 . 10.4261/1305-3825.DIR.2184-09.0
    PubMedGoogle Scholar
  • 25 Lazar HL, Varma PK, Shapira OM, Soto J, Shaw P. Endograft collapse after thoracic stent-graft repair for traumatic rupture. Ann Thorac Surg 2009; 87: 1582-1583 . 10.1016/j.athoracsur.2008.09.012
    CrossrefPubMedGoogle Scholar
  • 26 Idu MM, Reekers JA, Balm R, Ponsen K-J, de Mol BAJM, Legemate DA. Collapse of a stent-graft following treatment of a traumatic thoracic aortic rupture. J Endovasc Ther 2005; 12: 503-507 . 10.1583/04-1515R.1
    CrossrefPubMedGoogle Scholar
  • 27 Jonker FHW, Schlosser FJV, Geirsson A, Sumpio BE, Moll FL, Muhs BE. Endograft collapse after thoracic endovascular aortic repair. J Endovasc Ther 2010; 17: 725-734 . 10.1583/10-3130.1
    CrossrefPubMedGoogle Scholar
  • 28 Makaroun MS, Dillavou ED, Kee ST, Sicard G, Chaikof E, Bavaria J. , et al. Endovascular treatment for thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg 2005; 41: 1-9 . 10.1016/j.jvs.2004.10.046
    CrossrefPubMedGoogle Scholar
  • 29 Go MR, Siegenthaler MP, Rhee RY, Gupta N, Makaroun MS, Cho JS. Physiologic coarctation of the aorta resulting from proximal protrusion of thoracic aortic stent grafts into the arch. J Vasc Surg 20; 48: 1007-1011 . 10.1016/j.jvs.2008.05.027
    PubMedGoogle Scholar
  • 30 Cosin O, Rousseau H, Otal P, Cron C, Chabbert V, Joffre F. Late perforation of a thoracic aortic Dacron graft by a metallic stent-graft component. J Endovasc Ther 2006; 13: 676-680 . 10.1583/06-1881.1
    CrossrefPubMedGoogle Scholar
  • 31 Eggebrecht H, Baumgart D, Radecke K, von Birgelen C, Treichel U, Herold U. Aortoesophageal fistula secondary to stent-graft repair of the thoracic aorta. J Endovasc Ther 2004; 11: 161-167 . 10.1583/03-1114.1
    CrossrefPubMedGoogle Scholar
  • 32 Yavuz S, Kanko M, Ciftci E, Parlar H, Agirbas H, Berki T. Aortoesophageal fistula secondary to thoracic endovascular aortic repair of a descending aortic aneurysm rupture. Heart Surg Forum 2011; 14: E249-251 . 10.1532/HSF98.20101179
    CrossrefPubMedGoogle Scholar
  • 33 Chiba D, Hanabata N, Araki Y, Sawaya M, Yoshimura T, Aoki M, Shimoyama T. , et al. Aortoesophageal fistula after thoracic endovascular aortic repair diagnosed and followed with endoscopy. Intern Med 2013; 52: 451-455 . 10.2169/internalmedicine.52.9139
    CrossrefPubMedGoogle Scholar
  • 34 Muradi A, Yamaguchi M, Kitagawa A, Nomura Y, Okada T, Okita Y. , et al. Secondary aortoesophafeal fistula after thoracic endovascular aortic repair for a huge aneurysm. Diagn Interv Radiol 2013; 19: 81-84 . 10.4261/1305-3825.DIR.5912-12.1
    PubMedGoogle Scholar
  • 35 Hopkinson BR. Late failure of early-model endografts: a complication whose time has come?. J Endovasc Surg 1998; Aug; 5: 273
    CrossrefPubMedGoogle Scholar
  • 36 Milner R, Kasirajan K, Chaikof EL. Future of endograft surveillance. Semin Vasc Surg 2006; 19: 75-82
    CrossrefPubMedGoogle Scholar
  • 37 Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007; 357: 2277-2284 . 10.1056/NEJMra072149
    CrossrefPubMedGoogle Scholar
  • 38 Dias NV, Riva L, Ivancev K, Resch T, Sonesson B, Malina M. Is there a benefit of frequent CT follow-up after EVAR?. Eur J Vasc Endovasc Surg 2009; 37: 425-430 . 10.1016/j.ejvs.2008.12.019
    CrossrefPubMedGoogle Scholar
  • 39 Jones WB, Taylor SM, Kalbaugh CA, Joels CS, Blackhurst DW, Langan 3rd EM. , et al. Lost to follow-up: a potential under-appreciated limitation of endovascular aneurysm repair. J Vasc Surg 2007; 46: 434-440 ; discussion 440–441. 10.1016/j.jvs.2007.05.002
    CrossrefPubMedGoogle Scholar
  • 40 Sarac TP, Gibbons C, Vargas L, Liu J, Srivastava S, Bena J. , et al. Long term follow-up of type II endoleak embolization reveals the need for close surveillance. J Vasc Surg 2012; 55: 33-40 . 10.1016/j.jvs.2011.07.092
    CrossrefPubMedGoogle Scholar