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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2013 March;20(1):27-34
Successful endovascular repair of blunt traumatic thoracic aortic injury has no effect on acute or mid-term outcome of poly-traumatized patients: a demand for an excellent initial endovascular treatment
Thiere M. 1, Oberhuber A. 2, Link J. 1, Riepl C. 3, Orend K. H. 1, Muehling B. 1 ✉
1 Department of Vascular Surgery, University Hospital Ulm, Ulm, Germany;
2 Department of Vascular Surgery;
3 Department of Traumatology, University Hospital Ulm, Ulm, Germany
Aim: The aim of this paper was to evaluate acute and mid-term device related complications of thoracic endovascular repair (TEVAR) in patient with blunt traumatic aortic injury.
Methods: The study is a retrospective analysis of our prospective database on all TEVAR-treated patients with blunt traumatic aortic injury admitted to our vascular department. Database was analysed with special regard to device related complications in the acute situation and in mid-term follow-up.
Results: Fifty-seven patients (mean age: 40,1 years, range: 12 to 83 years) with blunt traumatic aortic injury were referred to the vascular department at the University of Ulm between March 1999 and June 2012. All of them were treated with TEVAR. 100% technical success was gained for endovascular procedure. In 34 patients (65%) origin of left subclavian artery was covered for a reliable proximal sealing zone. Overall in hospital mortality rate was 7%, the mortality rate related to aortic injury or repair was 1.75% as one patient died for consequences of stent-graft collapse. Device related complications were seen in 9 patients. Six of them in the perioperative setting: In 4 cases a too distal positioning of the first endograft, requiring a secondary more proximal delivered endograft and two patients with endograft collapses, one asymptomatic one with fatal outcome. Fatal collapse occurred in 2004. Causes led to collapse were a narrow angled aortic arch, an unfavourable placed, excessively oversized endograft of rigid design and thus bad alignment. 49 patients are left for follow-up controls. In mid-term follow-up three patients presented claudication of left arm doe to coverage of left subclavian artery, one of them with clinical subclavian steal syndrome. This one therefore needed revascularization. Further device related problems like secondary endoleaks, endograft migration or fracture etc. were not observed in mid-term follow-up. No patient suffers disability or a reduction of earning capacity concerning the aortic injury.
Conclusion: We postulate TEVAR to be first line therapy in patients with traumatic thoracic aortic injury and we suggest that successful endovascular repair of blunt traumatic thoracic aortic injury has no effect on acute or mid-term outcome of poly-traumatized patients. In our series one fatal device related complication took place. This complication was mainly attributable to lack of endovascular experience and old fashioned stent-graft design. With rising endovascular experience and improving endograft designs TEVAR should become even safer.