Emergency aortic stent grafting for traumatic rupture of the thoracic aorta

PCH Kwok, KK Ho, TKM Chung, SCH Chan, AKH Lai
Department of Radiology and Imaging, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong

OBJECTIVE. To investigate the role of aortic stent grafting in emergency treatment of traumatic rupture of the descending thoracic aorta in patients with multiple injuries.

DESIGN. Retrospective study.

SETTING. Cardiothoracic surgery facility of a tertiary referral hospital, Hong Kong.

PATIENTS. Between September 2001 and September 2002, four patients who had sustained a blunt injury to the chest after high-speed deceleration injury were recruited. Three patients were treated with stent grafting because concomitant head injury and multiple other injuries precluded the use of open thoracic surgery. One patient had no head injury and was offered stent grafting as a less invasive treatment.

INTERVENTION. The pseudoaneurysm was covered with an aortic stent graft under fluoroscopic and angiographic guidance.

MAIN OUTCOME MEASURES. Technical success of treatment, complications, and treatment outcome.

RESULTS. Three patients recovered and were discharged from hospital. The computed tomography scan at 3 months to 6 months after surgery showed resolution of the pseudoaneurysm. The final patient was still in the hospital. Follow-up computed tomography 2 weeks later showed exclusion of the pseudoaneurysm. There was one external iliac artery thrombosis on the side of femoral arteriotomy, which was recanalised with thrombectomy. There was another unintentional partial coverage of the left subclavian artery, which was asymptomatic. No other major complication was present and there was no paraplegia after the stent grafting.

CONCLUSION. Aortic stent graft is useful for emergency treatment of descending thoracic aortic injury. In the short term, it causes less morbidity and mortality than does open surgery, and can be life-saving when there is no surgical alternative. The long-term effect is still unknown.

Hong Kong Med J 2003;9:435-40

Key words: Aorta, thoracic; aortic rupture; Multiple trauma; Stents