Emergency stent-graft placement for hemorrhage control in acute thoracic aortic rupture1

• DOI: 10.1016/j.ejcts.2004.03.005
• Publication Date: 2004-04-22T05:45:31Z
• Authors: S MELNITCHOUK; T PFAMMATTER; A KADNER; H DAVE; H WITZKE; O TRENTZ; M TURINA; M LACHAT
• Keywords: Adult; Aged, 80 and over; Male; Aortic Rupture; 610 Medicine & health; Aorta, Thoracic; Hemorrhage; Middle Aged; 142-005 142-005; Survival Analysis; 2705 Cardiology and Cardiovascular Medicine; 2746 Surgery; 3. Good health; Blood Vessel Prosthesis Implantation; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; 2740 Pulmonary and Respiratory Medicine; Acute Disease; Humans; Female; Stents; Emergencies; Tomography, X-Ray Computed; Aged

To report mid-term results of stent-graft (SG) implantation in acute thoracic aortic rupture as alternative to conventional open surgery with its associated high morbidity and mortality rates.Out of a series of 69 patients undergoing thoracic aortic SG implantation since 1998, 24 (mean age 57+/-19 years, range 20-85-years-old) patients were treated on an emergency basis for hemorrhage control. The indication for SG placement was acute traumatic aortic rupture in 15 patients, type B dissection with contained rupture in 3 patients, penetrating aortic ulcer with periaortic hematoma in 3 patients, and thoracic aortic aneurysm rupture in 3 patients. Preoperative assessment was done by computed tomography (CT) scanning and echography. Patients were treated in the angiography suite by implantation of Excluder (n = 18) Talent (n = 4) Corvita (n = 1) and Vanguard (n = 1) self-expanding grafts. Local anesthesia was the most frequently used anaesthesiologic technique.Technical success rate of SG deployment was 100%. The early postoperative mortality was 12.5% (3 of 24). One patient suffered temporary paraplegia (4%). There was no intervention-related mortality during the mean follow-up of 34.1 months. Two secondary endoleaks were successfully treated with additional SG placement at 2 and 12 months postoperative, respectively.Emergency SG repair to control hemorrhage in patients with an acute thoracic aortic rupture is a less-invasive attractive and rational treatment option, especially if associated lesions or co-morbidity may interfere with the surgical outcome. Long-term follow-up results will be helpful to clarify procedure durability bounded by material failure and postoperative aneurysm or aortic wall remodelling.