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Medline ® Abstract for Reference 42

of 'Surgical and endovascular repair of blunt thoracic aortic injury'

Acute rupture of the descending thoracic aorta: repair with use of endovascular stent-grafts.
Semba CP, Kato N, Kee ST, Lee GK, Mitchell RS, Miller DC, Dake MD
J Vasc Interv Radiol. 1997;8(3):337.
PURPOSE: To describe the use of endovascular stent-grafts to treat acute ruptures of the descending thoracic aorta as an alternative to surgery in high-risk patients.
MATERIALS AND METHODS: From July 1992 to August 1996, 95 patients underwent stent-grafting of the descending thoracic aorta for a variety of lesions. Of these, 11 patients with acute (<or = 7 days) rupture from aneurysms (n = 8) or trauma (n = 3) underwent repair with use of endovascular stent-grafts. Rupture was confirmed with preoperative imaging studies and occurred in the mediastinum (n = 9), the pleural space (n = 1), or the lung (n = 1). All patients were considered high surgical risk due to generalized cardiopulmonary disease and/or previous thoracotomies. Stent-grafts were constructed from Z stents covered with polyester fabric and delivered through a catheter under fluoroscopic control from a remote access site.
RESULTS: Stent-graft deployment was successful in all patients. There were no complications of perigraft leak, stent migration, paraplegia, or intraoperative death. Two patientsdied in the follow-up period: one of ventricular perforation during unrelated thoracic surgery for tumor resection (day 1) and one of cardiac arrest (day 28). All others are alive (mean follow-up, 15.1 months).
CONCLUSION: For acute rupture of the thoracic aorta, endovascular stent-graft repair is technically feasible and may be a therapeutic alternative to a surgical interposition graft in patients considered high risk for conventional thoracotomy. Long-term studies are necessary to determine the role of stent-grafts in preventing future aortic rupture.
Division of Cardiovascular, Interventional Radiology-Stanford University School of Medicine, Stanford University Medical Center, CA 94305, USA.