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A Journal on Surgery

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Minerva Chirurgica 2008 October;63(5):329-34

language: English

Endovascular repair of aortic lesions associated to video-assisted thoracoscopy surgery after chest trauma

Monaco M., Mondello B., Spinelli F., Gaeta R., Carella G., Lentini S., Monaco F.

Department of Thoracic and Cardio-Vascular Surgery Policlinic Hospital University of Messina, Messina, Italy


Aim. Trauma of the thoracic aorta for blunt trauma shows a very high incidence of mortality. Hospital mortality rate after aortic open surgery is between 15% and 30%. Endovascular management represents an alternative treatment Associated lesions are usually seen in those critical patients. Hemothorax may be present. The authors propose a combined treatment of endovascular repair for the aortic lesion and video-assisted thoracoscopy surgery (VATS) for the treatment of chest bleeding complications.
Methods. The authors report a series of three patients with post-traumatic aortic lesion and hemothorax. In two patients endovascular procedure was first perfomed, followed by VATS, few days later, for retained hemothorax. In the third patient the two procedures were performed at the same time because of the patient’s critical conditions.
Results. There was technical success of stent-graft placement in all the treated cases. No postoperative mortality. No postoperative paraplegia. No VATS converted to thoracothomy. The postoperative follow-up time range between 10 and 19 months.
Conclusion. Considering the relatively short procedural time and minimally invasive approach of both techniques, the concomitant use of them may represent an alternative to standard open surgery in cases of thoracic aorta lesions associated with hemothorax. Those procedures may be performed sequentially or together in emergency cases with intra-thoracic more active bleeding to exclude or to treat intra thoracic bleeding.

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