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Endograft Repair of Traumatic Aortic InjuryA Technique in Evolution: A Single Institutions Experience

Neschis, David G. MD*; Moainie, Sina MD*; Flinn, William R. MD*; Scalea, Thomas M. MD†; Bartlett, Stephen T. MD*; Griffith, Bartley P. MD*

doi: 10.1097/SLA.0b013e3181b3b5c9
Original Articles

Objective: We evaluated a large single center experience of endograft repair of blunt traumatic injury of the thoracic aorta.

Summary Background Data: Traumatic aortic transection is a devastating injury with high morbidity and mortality. Endograft repair of these injuries has reduced the rates of death and paraplegia seen with open surgical treatment in the past. However, endograft repair has been associated with a higher incidence of device related failure.

Methods: The records of 43 consecutive cases of endograft treatment of traumatic aortic injury from December 2004 to November 2008 were reviewed. Patient demographics, procedure details, and outcomes were recorded. Aortic morphology was analyzed for predictors of device failure.

Results: Forty-three patients (32 men) with a mean age of 44 years (range: 17–88) were treated. Primary technical success was 86%. Six proximal endoleaks (14.3%) occurred. Two were repaired with a more proximal cuff, but 3 required explantation and open repair (7%). Mortality in this series was 11.6%, but no death was aorta related. No patient having endograft treatment suffered postoperative paraplegia. Early device failure is associated with sharp angulation of the aorta and shortened distance between the left subclavian artery and the site of injury. Follow-up ranged from 1 to 38 months (mean: 7.4 months). There were no late device failures or complications.

Conclusions: Endovascular repair of blunt 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.

Endograft repair can reduce the morbidity and mortality associated with blunt injury of the thoracic aorta. A single institution's experience of 43 cases of endograft repair, with an overall mortality rate of 11.6 and a paraplegia rate of 0, is evaluated. Aortic morphology is analyzed for predictors of device failure.

From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; and †R. Adams Cowley Shock Trauma Center, Baltimore, MD.

Reprints: David G. Neschis, MD, Associate Professor of Surgery, University of Maryland School of Medicine, Division of Vascular Surgery, University of Maryland Medical Center, 22 South Greene St, Room N4W66, Baltimore, MD 21201. E-mail: dneschis@smail.umaryland.edu.

© 2009 Lippincott Williams & Wilkins, Inc.