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The Journal of Cardiovascular Surgery 2001 February;42(1):77-81

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Endovascular treatment of aortic rupture by blunt chest trauma

Ruchat P., Capasso P. *, Chollet-Rivier M. **, Marty B., Von Segesser L. K.

From the Department of Cardio-Vascular Surgery *Interventional Radiology and **Anesthesiology University Hospital, Lausanne, Switzerland


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Background. The usu­al treat­ment of ­blunt aor­tic inju­ry (BAI) is ­prompt sur­gery. Frequently ­severe inju­ries to the ­brain or ­lungs ­exclude fur­ther sur­gi­cal treat­ment. The pur­pose of ­this ­study is to ­assess the fea­sibil­ity of plac­ing endo­vas­cu­lar ­stent-­grafts.
Methods. From 1992 ­through 1999, in our pri­mary and refer­ral trau­ma cen­ter, 26 ­acute BAI, 21 ­males and 5 ­females, ­mean age 40.2±16.3 yrs ­were diag­nosed. The ­last 4 ­patients under­went pros­pec­tive­ly endo­vas­cu­lar ­repair ­with Talent endo­graft. Endoprosthesis param­e­ters ­were meas­ured on ­three-dimen­sion­al spi­ral CT recon­struc­tion. While wait­ing for devic­es, ­blood pres­sure was aggres­sive­ly low­ered and aor­tic ­lesions ­were mon­i­tored by tran­se­soph­a­geal echog­ra­phy.
Results. Stent-­graft deploy­ment was suc­cess­ful in all 4 ­patients. There ­were no com­pli­ca­tions of endo­leak, ­stent migra­tion, par­a­ple­gia or ­death. Angiographic exclu­sion was com­plete in all 4 ­patients. CT scans at a ­mean fol­low-up of 11±5 ­months ­showed com­plete heal­ing of the aor­tic ­wall in all ­patients.
Conclusions. For ­stable ­acute BAI, endo­vas­cu­lar ­stent-­graft ­repair is fea­sible and ­safe, and is an effec­tive ther­a­peu­tic alter­na­tive to ­open sur­gery. Because of the nor­mal prox­i­mal and dis­tal ­wall in aor­tic inju­ries, endo­lu­mi­nal treat­ment ­might be the ther­a­py of ­choice in the ­near ­future.

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