Endograft Repair of Traumatic Aortic Injury - A Technique in Evolution
*David G Neschis1, *Sina Moainie1, *William R Flinn1, Thomas M Scalea2, Stephen T Bartlett1, Bartley P Griffith1
1University of Maryland Medical Center, Baltimore, MD;2R Adams Cowley Shock Trauma Center, Baltimore, MD
OBJECTIVE(S): Traumatic aortic transection is a devastating injury with high morbidity and mortality. Endograft repair has reduced the rates of death and paraplegia seen with open surgical treatment. This study reviewed the largest single center series of endograft repair of traumatic aortic injury. Recognition of patterns of device failure has led to technical refinements.
Records of 43 consecutive cases of endograft treatment of traumatic aortic injury from December 2004-November 2008 were reviewed. Patient demographics, procedure details, and outcomes were recorded.
43 patients (32 male) - mean age 44 years (range 17-88) were treated. Primary technical success was 86%. Device failure was associated with injuries near a sharp aortic angulation. Five proximal endoleaks (11%) occurred. Two were repaired with a more proximal cuff, but 3 required explantation and open repair (7%). Technical refinements reduced the incidence of device failure from 15% (first 20 patients) to 9% (last 23). Mortality was 13%; no death was aorta-related. No patient having endograft treatment suffered postoperative paraplegia. Follow-up has ranged from 1-38 months (mean 7.4 months). There were no late device failures or complications.
CONCLUSIONS: Endovascular repair of traumatic aortic injury can be performed with a low morbidity and mortality. Anatomic patterns in the aortic arch appear to be predictive of early device failure. Midterm durability is excellent, but reliable follow-up remains challenging in this group of patients