Abstract
Background The recently developed thoracic endovascular repair (TEVAR) technique seems to offer
a good alternative for treating acute traumatic transection of the thoracic aorta
(TTA). We reviewed our experience of TEVAR in cases of acute traumatic transection
and analyzed the subsequent remodeling changes.
Methods The medical records of 17 patients who underwent TEVAR for TTA were reviewed. The
trauma mechanisms, anatomical characteristics of the transected aortas, technical
details of TEVAR, and postprocedural results were reviewed.
Results The overall mean injury severity score was 53 ± 12. On three-dimensional computed
tomography (CT), the mean distance of transection from the left subclavian artery
was 14 ± 9 (0–31) mm. Fifteen patients presented an aortic pseudoaneurysm and two
patients had impending rupture. TEVAR was performed emergently under general endotracheal
induction. Technical success was achieved and complete pseudoaneurysm sealing was
confirmed with aortography in all 17 patients. Two patients (12%) died of hypovolemic
shock and hyperkalemia; however, no late death or stent-related complication occurred
during the 45 ± 32 (6–102) months of follow-up. During a mean CT follow-up of 35 months,
the mean aortic diameter increased by 2 (0–5) mm and pseudoaneurysm lesions completely
disappeared in all patients.
Conclusions TEVAR resulted in good early survival in patients with TTA. No late or stent graft-related
event was encountered up to a maximum of 9 years after surgery. We recommend that
patients with grade III or higher TTA should undergo emergency surgery. Moreover,
we consider that long-term follow-up and blood pressure management are essential when
the proximal aortic diameter is found to increase slightly after TEVAR on follow-up
CT.
Keywords
aorta - trauma - stent graft
