Acute-stage TEVAR for traumatic aortic rupture

摘要

abstract_textpSince March 1999, 52 thoracic endovascular aortic repair (TEVAR) procedures have been done acutely as part of primary polytrauma repair in 48 patients after thoracic aortic rupture. In the presence of aortic diameters of 12-30 mm, only the smallest thoracic stent graft systems available from Gore, Medtronic, and Cook-in one instance, an iliac extension limb-were used. The primary success rate (sealing of the aorta) was 100. Three patients died from serious concomitant injuries unrelated to the aorta. Of three cases of acute stent compression syndrome, one proved to be lethal. Contemporary stent graft systems show conformability deficits at the narrow curvature of the juvenile aortic arch, with consequent disattachment phenomena and disattachment angles at the inner aortic curvature of up to 63A degrees end-systolic. Nevertheless, the conversion rate up to 10 years was 0, and no stent corrections were necessary after 30 days. Two additional patients died during the long-term observation period (after 3 and 5 years, respectively) after non-aorta-related trauma. All other patients are under supervision in a special magnetic resonance imaging assessment program; the majority are back to their normal activities and are seen regularly once a year. Ten years of follow-up is a long time, but not long enough in these young patients. Therefore, the definite role of TEVAR can be determined only after another 20 years./p/abstract_text