Immediate endovascular treatment of blunt aortic injury: mid-term results

Objective: Post-traumatic aortic rupture is a potentially lethal injury. Stentgraft
repair has recently proved to be a valid option for these patients.
Timing of the treatment, anyway, is still a debated issue. We here report
mid-term results of our experience with immediate stent graft repair.
Methods: From 1998 to 2006 17 patients (12 males, five females) with
blunt aortic injury were submitted to immediate endovascular repair. In
ten patients with clinical and radiological signs of impending rupture stent
grafting was performed on an emergency setting. In the remaining seven
patients aortic lesion was treated urgently after clinical management. When
present, immediate life-threatening non-aortic lesions were treated before
endovascular treatment (seven cases). In one case emergent laparotomy and
stent positioning were performed simultaneously. Endovascular procedure
was carried out in a cardiac surgery operating theatre and monitored by
trans-oesophageal echocardiography in all cases.
Results: Stent grafting was successful in 100% of the patients. Two patients
died perioperatively as a consequence of a multi-organ failure. Both patients
were in ASA class V and presented severe intractable hemorrhagic shock
before procedure. CT scan performed before discharge showed correct positioning
of the stent-graft and absence of endoleaks in all cases. At a mean
follow-up of 36 months (range 1–72) all patients are alive and no intervention
related complication occurred.
Conclusions: Immediate endovascular repair of blunt aortic injury is a feasible
and safe procedure. Mid-term results are promising. Longer follow-up
and larger series are mandatory to definitively validate this approach.