(Circulation. 1999;99:498-504.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Delayed Treatment of Traumatic Rupture of the Thoracic Aorta With Endoluminal Covered Stent
From the Departments of Radiology (H.R., P.P., B.J.D., G.M., F.J., P.O.), Cardiovascular Surgery (P.S., P.C.), and Cardiology (P.M.) and the Intensive Care Unit (M.M.), Centre Hospitalier Universitaire, Hôpital de Rangueil, Toulouse, France, and the Department of Radiology, Centre Hospitalier de l'Université de Montréal, Campus Saint-Luc, Montréal (Québec), Canada (B.B.).
Correspondence to Professor H. Rousseau, MD, Service de Radiologie, CHU Rangueil, 1, Avenue Jean Poulhès, 31403 Toulouse Cedex 4, France. E-mail rousseau.h{at}chu-toulouse.fr
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionReferences |
|---|
Background—Stent grafting is emerging as a new treatment for several pathological conditions involving the thoracic aorta. We studied the feasibility and safety of this technique for delayed treatment of ruptures of the aortic isthmus.
Methods and Results—Nine patients (14 to 76 years old; mean, 37 years; male/female ratio, 8/1) underwent stent grafting of the aortic isthmus in subacute (n=5) or chronic (n=4) aortic traumatic rupture after a motor accident. In subacute ruptures, this treatment was delayed (1 to 8 months; mean, 5.4 months) because of the severity of other associated injuries. Stent grafting was technically successful (defined as complete exclusion of the pseudoaneurysmal sac) in all patients. Short-term fever and biological inflammatory syndrome occurred in 3 patients. Two major complications occurred: in 1 patient, an early occlusion of the left subclavian artery was treated by placement of 2 Palmaz stents. In another patient, an atelectasis related to an increase of preexisting compression of the left main bronchus by the pseudoaneurysmal sac was successfully treated by temporary placement of an endobronchial silicone stent. Mean follow-up was 11.6 months (range, 3 to 21 months). Thrombosis of the pseudoaneurysmal sac was found in all patients.
Conclusions—In the absence of available extended follow-up about the safety and effectiveness of endovascular grafting, this approach seems to be a viable therapeutic option for traumatic rupture of the aortic isthmus, but appropriately controlled prospective studies are needed before we can recommend its widespread use.
Key Words: aorta • prosthesis • stents • grafting • surgery
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Rupture of the thoracic aorta due to blunt chest trauma leads to immediate death in 75% to 90% of cases1 2 and accounts for up to 18% of deaths in motor vehicle accidents.3 Approximately 15% to 20% of the victims reach the hospital alive.4 In survivors, blood flow is precariously maintained within the vascular lumen by the adventitia and mediastinal surrounding tissues only. Very few aneurysms remain stable over time; the majority tend to expand and rupture. Finkelmeier et al5 reported that 20 of 60 patients with untreated chronic aortic aneurysm died of aortic complications. Other complications, such as distal embolization, compression, or fistulization to adjacent organs, can be observed.6 7 For all these reasons, early surgical repair is the standard method of treatment for any aortic injury. Nevertheless, some investigators advocate delaying repair by a few weeks for patients in stable condition, particularly when severe neurological lesions are present.6 7 8 9 10 11 12 13 14 15
Since the pioneering publication by Parodi et al in 1991,16 the safety and efficacy of transfemoral intraluminal stent-graft implantation for the treatment of peripheral and aortic aneurysms seems to be confirmed by many authors.17 18 19 20 21 Although most investigation is currently focused on abdominal aortic aneurysm, there is sometimes an even greater need for this technique in thoracic aortic diseases.
The purpose of this study was to demonstrate the feasibility and safety of delayed treatment of thoracic aortic injury by transluminal placement of endovascular covered stents.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Study Group
We prospectively studied 9 patients (8 men and 1 woman) whose age ranged from 14 to 76 years at the time of the procedure (mean, 37 years) (Table
). The indication for
stent grafting of the thoracic aorta was subacute or chronic
traumatic subadventitial rupture of the aortic isthmus sustained after
a motorbike or car accident. In the subacute group (n=5), the delay
between initial trauma and stent-grafting procedure ranged from 1 to 8
months (mean, 5.4 months), and no calcification was found on the wall
of the pseudoaneurysm. Delay of the endoluminal aortic
intervention in our 5 subacute patients was always warranted by the
patient's hemodynamic stability and the severity and
number of other associated injuries and by the presence of additional
sepsis in 1 of them. Moreover, the risk of intrathoracic exsanguination
was thought to be rather low in the absence of clinical evidence of
active, ongoing hemorrhage.
|
Between 1980 and 1995, 30 patients were admitted to our hospital in whom an acute thoracic aortic rupture was diagnosed. Of these, 23 underwent emergency surgery within 48 hours after the trauma and 7 were operated on later, between 12 days and 13 years after the trauma. Since the introduction of aortic stent grafting in our institution, 14 more patients with acute thoracic aortic rupture were admitted to the emergency department over the following 2-year period (1996–1997). Of these, 5 were treated by stent grafting; 1 was operated on; 4 died within 24 hours or 9 days, each of them because of another associated severe traumatic lesion (no secondary rupture of the thoracic aorta); and 4 had minor aortic lesions that were only followed by MRI every 6 months. All of the operations, either in the emergency department or delayed, were performed under extracorporeal circulation (60% of patients) or with aortic clamping (40%). Surgical morbidity included paraplegia in 6.5% of patients (2/31) and postoperative arterial hypertension in 22.6% (7/31); the mortality rate was 16.1% (5/31).
Chronic rupture was postulated in the 4 oldest patients, who had sustained their accidents between 10 and 32 years (mean, 20 years) before endoluminal repair. All of them presented with peripheral calcifications on their pseudoaneurysmal sac, and the isthmic location (known as the preferential site of traumatic aortic injury in >85% of patients22 ) and circumferential aspect of the aneurysm were highly suggestive of chronic traumatic aortic lesion, in the absence of evident atheromatosis, dissection, or infection. Indications for treatment in the chronic group were either aortic expansion (n=1) or aortic diameter >60 mm (n=3). The choice for endovascular technique was the patients' preference in all 5 cases.
The maximum size of the pseudoaneurysmal sac ranged from 26 to 70 mm (mean, 42.2 mm).
Except for 2 patients with a history of heavy smoking, none of our patients presented risk factors other than those related to their previous trauma: paraplegia (n=1), splenectomy (n=1), past history of meningeal hemorrhage (n=1), pulmonary contusions (n=5), left kidney and spleen contusion (n=1), and multiple fractures (n=6). One patient had developed chronic active hepatitis C after transfusions received during initial trauma. All patients were classified, at the time of procedure, in American Society of Anesthesiologists class II (n=7) or III (n=2).
Preprocedural Imaging Studies
Thoracic spiral CT and digital subtraction angiography of the
thoracic aorta with a calibrated catheter were performed for measuring
and localizing purposes. The graft diameter was oversized by 10% to
achieve a tight friction seal, and the length was 2 cm longer than the
lesion treated.
Stent-Graft Device
The endovascular devices used in our first 2 patients were
straight stent grafts (MinTec), 22x80 and 26x90 mm,
respectively, both with a 12-mm bare portion at the proximal end and an
outer polyester covering. The introduction caliber of the compressed
stent grafts was 18F (ie, 6 mm in diameter). Another type of
device was used in the last 7 patients (Talent, World Medical
Manufacturing Corp), whose diameter ranged from 24 to 34 mm (mean,
27.7 mm) and length from 80 to 100 mm, with 15 mm bare
at the proximal end. It has 2 V-shaped radiopaque markers at
both ends of the polyester outer covering that allow a more precise
placement. No degressive stent graft was used. The introduction caliber
of these last 7 stent grafts ranged from 22F to 27F (ie, up to 9
mm in diameter). In 1 patient, stent-graft design was customized to
include a 17x21-mm proximal indentation in the covered portion,
centered on the external curvature connecting bar, to avoid covering
the left subclavian artery ostium with the polyester tube. This
modification was dictated by the particular configuration of the aortic
rupture, with a nearly nonexistent neck between the left subclavian
artery ostium and the upper limit of the pseudoaneurysmal
neck.
Stent-Grafting Procedure
Prior informed consent was obtained from all patients, and a
team of interventional radiologists and vascular surgeons performed the
endovascular procedure under general anesthesia, with
tracheal intubation and mechanical ventilation. The procedure was
conducted in a sterile radiological vascular interventional suite (in
accordance with the World Health Organization's recommendations on air
handling in surgical suites). The patient was positioned in the dorsal
decubitus position, and the operative field was prepared and draped for
thoracotomy in the event that the endovascular device could not be
deployed or a major complication occurred. Cardiopulmonary
bypass equipment was readily available, should such a complication
occur.
In all patients, arterial access for introducing the stent graft was the right (n=7) or left (n=1) femoral artery and the left external iliac artery (n=1). The artery was surgically isolated, and a transverse arteriotomy was performed after an intravenous bolus of 5000 IU heparin. We did not have to use any side-limb graft attached to the lower aorta or the common iliac artery to allow stent-graft insertion. Additional axillary arterial accesses were gained to allow (1) easy completion of control angiograms during procedures, (2) straightforward marking off of the left subclavian artery ostium just before stent-graft deployment, and (3) in some cases, direct invasive arterial pressure monitoring. Periprocedural transesophageal echocardiography (TEE) was performed to guide the stent-grafting procedure before and during deployment of the device. An initial aortogram with a 5F pigtail catheter introduced through the axillary access helped to obtain the best incidence. A 260-cm-long, 0.035-in stiff guidewire (Amplatz, Meditech) was advanced up to the aortic arch under fluoroscopic and TEE guidance. The delivery system was positioned at the preestablished level in front of the aortic tear. A mean arterial pressure <70 mm Hg was maintained during implantation, and the outer sheath was slowly withdrawn to fully deploy the implant. Thereafter, the compliant balloon included with the stent-graft package was inflated with sterile hot saline solution to fully anchor the stent into the nonaneurysmal wall of the aorta.
In 2 patients, the proximal part of the stent graft was 1 cm below the
ostium of the left subclavian artery and the distal end a few
centimeters below the aortic rupture (Figure 1). In 6 patients, the stent graft was
deployed with the first proximal noncovered end on the left subclavian
artery ostium because of the close proximity of the
pseudoaneurysmal sac. As long as only the bare portion of the
stent graft covered the ostium of the left subclavian artery, this
artery remained patent, with good opacification in all cases (Figure 2). In 1 patient, we had to cover the
left subclavian artery ostium by the polyester tube to exclude the
pseudoaneurysm, and the patency of the left subclavian artery
was obtained by placement of 2 Palmaz stents (Figure 3).
|
|
|
Finally, the introducer delivery system was removed, and the arteriotomy was repaired after arteriographic and TEE controls. Anticoagulation was maintained for 48 hours and then followed by aspirin 250 mg/d.
Follow-Up
Further imaging follow-up consisted of TEE (at 3, 6, 12, and 18
months) and spiral CT (before discharge and at 3, 6, 12, and 18 months)
after the intervention, except for 3 patients who were followed only by
CT. Mean follow-up was 11.6 months (3 to 21 months).
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Primary Technical Results
Digital subtraction angiography and perioperative TEE revealed complete exclusion of the pseudoaneurysm in all 9 patients (100%), without any immediate leak. Only 1 stent graft was needed in each patient. In 1 patient, arteriotomy had to be extended up to the left external iliac artery because of insufficient length of the standard stent-graft delivery system (MinTec).
Hospital Stay Duration After Procedure
Seven patients could be discharged in good condition between
postoperative days 3 and 10, after performance of a spiral CT
examination. The 2 remaining patients had to stay in hospital for
several weeks because of coexisting diseases. Pseudoaneurysmal
lumen thrombosis was found in all cases on follow-up TEE and CT control
examinations.
Complications and Management
No death, neurological complication, or infection was observed,
but early after intervention, fever, neutrophilic hyperleukocytosis,
and biological inflammatory syndrome for 1 to 5 days (mean, 2.7 days)
were observed in 3 patients; no causal infectious agent could be
identified. Blind broad-spectrum antibiotics were given to 2 patients
to cover an eventual stent-graft infection. The significance of these
features is uncertain, but they could be related to the
"postimplantation syndrome" described in stent grafting for
abdominal aortic aneurysms.21
No significant kinking, twisting, stenosis, intragraft thrombosis, migration, perigraft leak, pseudoaneurysmal expansion, or rupture was observed. Three patients showed minimal deformity of the inner face of the stent graft in front of the aortic rupture due to the complete expansion of the graft, without significant stenosis either at end of procedure or on follow-up imaging controls.
Two major complications were observed. (1) In 1 patient, the covered part of the stent graft encroached on the left subclavian artery aortic ostium, necessitating further placement of 2 Palmaz stents to open the Dacron at this level; patency was later shown on arteriographic and CT controls. In the same patient, occlusion of the left superficial brachial artery occurred at the puncture site and was treated only medically. Follow-up clinical examinations and color Doppler ultrasounds (up to 15 months later) showed downstream reentry, weak but present radial and cubital pulses, and moderately asymmetrical systolic pressures (150 mm Hg in the right arm versus 120 mm Hg in the left). (2) In 1 patient with a past history of severe septic context and neurological impairment, acute compression of the left main bronchus and homolateral pulmonary atelectasis occurred soon after the procedure; it was believed to be related to a sudden rise in pressure inside the freshly thrombosed pseudoaneurysmal sac. A Dumon endobronchial silicone stent was placed with good clinical and bronchoscopic results; it was retrieved 3 months later.
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
The timing of repair of traumatic injury of the aorta is still controversial. For many decades, standard surgical practice has dictated that traumatic rupture of the thoracic aorta must be diagnosed quickly and managed aggressively by immediate surgical repair. More recently, the concept of deliberately delayed surgical repair has been reported in the literature.6 7 8 9 10 11 12 13 14 15 It stands to reason that immediate surgical repair of aortic injury is mandatory if a significant hemothorax or a pseudocoarctation syndrome indicates impending free rupture. However, in the majority of patients who reach the hospital alive, the adventitia and surrounding mediastinal structures remain more or less intact, thus partially preserving the integrity of the disrupted aorta and preventing acute exsanguination into the thorax.23 In fact, provided that adequate antihypertensive treatment is given, exsanguination due to delayed free rupture of an initially stable aortic tear may be less frequent than previously assumed. Supporting this hypothesis is a retrospective analysis of 5752 autopsies in which 168 subjects had acute disruption of the thoracic aorta24 : 166 of them died within 2 hours of the accident, precluding surgery, but only 1 patient died of delayed rupture of a periaortic hematoma. In a review of the American literature, Walker and Pate25 found 64 patients with thoracic aortic trauma treated initially by conservative therapy; free rupture of the periaortic hematoma did not occur in any of them. Maggisano et al15 demonstrated an operative mortality of 9% when using a more selective approach consisting of immediate repair for unstable patients and for stable patients with no contraindications to this early repair, and deliberately delayed repair for patients with concomitant injuries or sepsis. This compares favorably with the operative mortality of 21.3% in a 20-year meta-analysis.26
Pate et al10 found that the risk of developing free rupture after arrival at the hospital with the periaortic hematoma contained in the mediastinum appeared to be considerably lower than the risk involved in emergency aortic repair in patients with serious associated injuries. Moreover, they showed that no patient whose systolic arterial pressure was maintained at <140 mm Hg by drug therapy developed free rupture. They remind us that 1 of the major determinants of rupture of the pseudoaneurysm is the left ventricular systolic ejection dynamics, which suggests that the use of ß-blockers is even more essential than simple antihypertensive therapy. All our patients were closely monitored for any rise in blood pressure. The goal was to maintain a mean arterial pressure <80 mm Hg. This was achieved with a combination of a ß-blocker and vasodilators.
Moreover, controversy remains regarding the best method of
intraoperative management. A meta-analysis of articles
concerning the surgical management of acute traumatic rupture of the
descending thoracic aorta has been reported.26 It showed
that the risk of paraplegia complicating surgery on
hemodynamically stable patients with acute rupture of
the thoracic aorta is 
2.3%, even if active distal perfusion is
provided. With either passive shunting or simple aortic cross-clamping,
the risks of paraplegia are 11.1% and 19.2%, respectively. However,
full systemic heparinization, needed for active distal perfusion, is
very risky in patients with acute traumatic rupture of the aorta
because of the high incidence of associated cerebral and visceral
injuries. Heparinization has been suggested to contribute to morbidity
by aggravating neurological injuries,27 causing
intrapulmonary hemorrhage, and increasing surgical
mortality.27 28 29 Data from this meta-analysis
documented a higher mortality in patients treated with systemic
heparinization (18.2%) as opposed to those who did not receive heparin
(11.9%). Thus, patients with multisystem lesions have to be carefully
evaluated to establish a plan of therapy for each injury.
In combination with aggressive medical management by reducing cardiac shear forces, standard therapy involves surgical placement of an interposition graft through a thoracotomy. Currently, less invasive strategies are being investigated for elective therapy of thoracic aortic lesions with use of endovascular stent grafts. The theoretical advantages of endovascular treatment of acute rupture of the thoracic aorta are multiple: a simple arteriotomy is performed without thoracotomy or aortic clamping, and the length of the covered aorta is limited to the diseased segment, which theoretically lessens the risk of medullar ischemia. Furthermore, severe head injury and pulmonary contusions pose fewer problems with this approach because, for the former, the absence of aortic cross-clamping prevents an intracranial pressure rise, and for the latter, there is no need for intraoperative 1-lung ventilation. And finally, because stent-graft insertion can be done with mild anticoagulation, the major bleeding complications observed with a surgical full heparinization could theoretically be avoided.
A Stanford team30 recently reported a series of 82 selected patients with descending thoracic aortic aneurysms treated by transluminal stent-graft placement. They observed a mortality rate of 8.5% and a paraplegia rate of 3.6%. In our study, we did not experience any major coexisting morbidity, including such complications as heart failure, renal failure, neurological complications, or distal embolization or infection. Every pseudoaneurysm was treated in 1 step with only 1 stent graft, and no leak was observed. The precise sizing of the device is certainly the most critical point of these endovascular procedures. We use data from the digital subtraction angiogram with a calibrated catheter and spiral CT with multiple angles of view provided by 3D reconstructions to thoroughly evaluate neck lengths, topography of the pseudoaneurysm in relation to branch vessels, and aortic diameters.
Because the isthmus is involved in >85% of traumatic aortic injuries,22 it may be difficult to treat these lesions by stent grafts, for different reasons. A relatively rigid device could be difficult or dangerous to cross in a very angulated aortic arch. The aneurysm frequently originates just beyond the left subclavian artery with an insufficient proximal anchoring length to have a safe support of the stent graft on healthy aortic wall. This was observed 7 times in this series, and it was resolved by different means: (1) the noncovered part of the stent graft was intentionally placed over the ostium of the left subclavian artery in all but 2 patients, leaving the polyester covering starting just after this ostium; (2) a small preimplant window was created in the polyester in front of this ostium at manufacturing; and (3) a hole was made inside the polyester after graft insertion, and this channel was calibrated by dilatation and stenting. By these techniques, no arm ischemia or neurological complication was observed, and it was not necessary to create a carotid-to-subclavian arterial bypass graft before or after stent-graft insertion.
The rigidity of the stent graft could be also a problem, because an inability to hug the aortic arch securely might cause a perigraft leak. We did not observe this complication. We used 2 different devices for this study, and in our opinion, it seems that the Talent device, with a conical shape of the proximal part of the stent, is more appropriate for this indication, allowing a better proximal fixation and avoiding partial protrusion of the polyester inside the aortic lumen as encountered with straight devices. Some homemade devices17 30 31 33 have been illustrated in isolated case reports; their reproducibility is limited on a large scale. Other available devices are manufactured but seem to be less adapted to endovascular techniques, as a result of their rigidity and the size of their introducing system.
Our preliminary experience demonstrates the feasibility and safety of this method, but the durability of stent-graft material and the fixation system, which is crucial to the success of this technique, are a subject of concern.21 So far, it seems that this technique may be of practical value for elderly patients or patients with coexisting conditions that would increase the risk in conventional operative treatment.
Moreover, the effect of endoluminal grafting on paraplegia rates is unknown. If we compare stent graft with surgery, it is true that stent graft eliminates the opportunity to reimplant intercostal arteries, so stent grafts may expose the patient to a higher risk of paraplegia. But for aortic lesions located at the isthmus, this risk is relatively low because branches to the spinal cord are rarely involved by this segment. This hypothesis seems to be confirmed by our series and by Kato et al.31
For all these reasons, that new therapeutic strategy seems to be very appealing. However, a few drawbacks are worth mentioning. (1) The covered stents currently in use can treat only aortas with a diameter <40 mm. (2) The caliber of the delivery system is quite important (18F to 24F), which can potentially be problematic with the small and spastic arteries of young people and the tortuous and rigid arteries of older people. In these cases, iliac or aortic access could be necessary. We hope that future technical developments will yield improved stent-graft design, particularly for the flexibility and size of the introducer. (3) Currently, these devices are not available in the angiography suite in the emergency department, because each device must be individually designed according to the measurements obtained by specific preprocedure imaging. But in the near future, we can expect to have a sufficient inventory of devices available for emergency cases.
This raises the question of whether it is justified to use this new approach to replace standard treatment in patients who have the usual indications for surgery with no major systemic or local factors that increase risk and contraindicate standard therapy. It is well known that surgical repair of a chronic aneurysm, particularly in young patients, has excellent long-term results. Nevertheless, the postoperative mortality rate of 5% to 18% and a morbidity rate associated with minor complications, including Horner syndrome and vocal cord paralysis,5 32 as high as 52.9% can justify the trial of a less invasive and potentially safer treatment.
The minimally invasive nature of endovascular prostheses makes them very attractive in accordance with the new trend in surgery to develop less invasive procedures to achieve treatment goals with reduced operative risk and complications. In this condition, a stent-graft procedure may lead to a reduction of the cost of hospitalization. However, because the devices and techniques for inserting endovascular grafts are still in the early stages of development, we should follow reasonable guidelines that have been created to direct the development of the technique and to prevent unjustified overuse.33
Received May 28, 1998; revision received September 22, 1998; accepted October 13, 1998.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
1. Parmley LF, Mattingly TW, Manion WC, Jahnke EJ. Nonpenetrating traumatic injury of the aorta. Circulation. 1958;17:1086–1100.[Medline] [Order article via Infotrieve]
2. Williams JS, Graff JA, Uku JM, Steinig JP. Aortic injury in vehicular trauma. Ann Thorac Surg. 1994;57:726–730.[Abstract]
3.
Greendyke RM. Traumatic rupture of the aorta: special
reference to automobile accidents. JAMA. 1966;195:527–530.
4. Merrill WA, Lee RB, Hamman JW, Frist WH, Stewart JR, Bender HW. Surgical treatment of acute traumatic tear of the thoracic aorta. Ann Surg. 1988;207:699–706.[Medline] [Order article via Infotrieve]
5. Finkelmeier BA, Mentzor RM, Kaiser DL, Tegtmeyer CJ, Nolan SP. Chronic traumatic thoracic aneurysm. J Thorac Cardiovasc Surg. 1982;84:257–266.[Abstract]
6. Frykberg ER, Crump JM, Dennis JW, Vines FS, Alexander RH. Non operative observation of clinically occult arterial injuries: a prospective evaluation. Surgery. 1991;109:85–96.[Medline] [Order article via Infotrieve]
7.
Prêtre R, Chilcott M. Blunt trauma to the heart
and great vessels. N Engl J Med. 1997;336:626–632.
8. Akins CW, Buckley MJ, Dagget W. Acute traumatic disruption of the thoracic aorta: a ten year experience. Ann Thorac Surg. 1981;31:305–309.[Abstract]
9. Stiles QR, Cohlmia GS, Smith JH. Management of injuries of the thoracic and abdominal aorta. Am J Surg. 1985;150:132–140.[Medline] [Order article via Infotrieve]
10. Pate JW, Fabian TC, Walker W. Traumatic rupture of the aortic isthmus: an emergency? World J Surg. 1995;19:119–126.[Medline] [Order article via Infotrieve]
11. Fisher RG, Oria RA, Mattox KL, Whigham CJ, Pickard LR. Conservative management of aortic lacerations due to blunt trauma. J Trauma. 1990;30:1562–1566.[Medline] [Order article via Infotrieve]
12. Stulz P, Reymond MA, Bertschmann W, Graedel E. Decision-making aspects in the timing of surgical intervention in aortic rupture. Eur J Cardiothorac Surg. 1991;5:623–627.[Abstract]
13. Striffeler H, Leupi F, Kaiser G, Althaus U. Traumatic rupture of the thoracic aorta in childhood with special reference to the therapeutic strategy. Eur J Pediatr Surg. 1993;3:50–53.[Medline] [Order article via Infotrieve]
14. Kipfer B, Leupi F, Schuepbach P, Friedli D, Althaus U. Acute traumatic rupture of the thoracic aorta: immediate or delayed surgical repair? Eur J Cardiothorac Surg. 1994;8:30–33.[Abstract]
15. Maggisano R, Nathens A, Alexandrova Na. Traumatic rupture of the thoracic aorta: should one always operate immediately? Ann Vasc Surg. 1995;9:44–52.[Medline] [Order article via Infotrieve]
16. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491–499.[Medline] [Order article via Infotrieve]
17.
Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ,
Liddell RP. Transluminal placement of endovascular stent-grafts for the
treatment of descending thoracic aortic aneurysms. N
Engl J Med. 1994;331:1729–1734.
18. Marin ML, Veith FJ, Cynamon J. Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions. Ann Surg. 1995;222:449–469.[Medline] [Order article via Infotrieve]
19. Rousseau H, Gieskes L, Joffre F. Percutaneous treatment of peripheral aneurysms with the Cragg Endopro system. J Vasc Interv Radiol. 1996;7:35–39.[Medline] [Order article via Infotrieve]
20. Mitchell RS, Dake MD, Sembra CP. Endovascular stent-graft repair of thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 1996;11:1054–1062.
21.
Blum U, Voshage G, Lammer J. Endoluminal stent-grafts
for infrarenal abdominal aortic aneurysms. N Engl
J Med. 1997;336:13–20.
22. Duhaylongsod FG, Glower DD, Wolfe WG. Acute traumatic aortic aneurysm: the Duke experience from 1970 to 1990. J Vasc Surg. 1992;15:331–343.[Medline] [Order article via Infotrieve]
23.
Dart CH, Braitman HE. Traumatic rupture of the thoracic
aorta: diagnosis and management. Arch Surg. 1976;111:697–702.
24. Kalmar P, Otto CD, Rodelwald G. Selection of proper time for operation of traumatic thoracic aortic aneurysms. Abstract presented at the 11th Annual Meeting of the German Society of Cardiovascular Surgeons, 1982, Bad Nauheim, Germany.
25. Walker WA, Pate JW. Medical management of acute traumatic rupture of the thoracic aorta. Ann Thorac Surg. 1990;50:965–967.[Abstract]
26. Von Oppell UO, Dune TT, De Groot MK, Zilla P. Traumatic aortic rupture: twenty-year metaanalysis of mortality and risk of paraplegia. Ann Thorac Surg. 1994;58:585–593.[Abstract]
27. Mattox KL, Holzman M, Pickard LR, Beall AC Jr, De Bakey ME. Clamp repair: a safe technique for treatment of blunt injury to the descending thoracic aorta. Ann Thorac Surg. 1985;40:456–463.[Abstract]
28. Vasko JS, Raess DH, Williams TE. Nonpenetrating trauma to the thoracic aorta. Surgery. 1977;82:400–406.[Medline] [Order article via Infotrieve]
29. Stavens B, Hashim SW, Hammond GL. Optimal methods of repair of descending thoracic aortic transections and aneurysms. Am J Surg. 1983;145:508–513.[Medline] [Order article via Infotrieve]
30. Mitchell RS, Miller DC, Dake MD. Stent-graft repair of thoracic aortic aneurysms. Semin Vasc Surg. 1997;10:257–271.[Medline] [Order article via Infotrieve]
31.
Kato N, Dake MD, Miller DC, Semba CP. Traumatic
thoracic aortic aneurysm: treatment with endovascular
stent-grafts. Radiology. 1997;205:657–662.
32. Bacharach JM, Garratt KN, Rooke TW. Chronic traumatic thoracic aneurysm: report of two cases with the question of timing for surgical intervention. J Vasc Surg. 1993;17:780–783.[Medline] [Order article via Infotrieve]
33. Veith FJ, Abbott WM, Yao JS, Endovascular Graft Committee. Guidelines for development and use of transluminally placed endovascular prosthetic grafts in the arterial system. J Vasc Surg. 1995;21:670–685.[Medline] [Order article via Infotrieve]
This article has been cited by other articles:
 |
|
 |
|
  A. Asmat, L. Tan, M. G. Caleb, C.-N. Lee, and P. A. Robless Endovascular Management of Traumatic Thoracic Aortic Transection Asian Cardiovasc Thorac Ann, October 1, 2009; 17(5): 458 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Nienaber, I. Akin, R. Erbel, and A. Haverich CHAPTER 31 Diseases of the Aorta and Trauma to the Aorta and the Heart ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Botta, V. Russo, C. Savini, K. Buttazzi, D. Pacini, L. Lovato, C. La Palombara, M. Parlapiano, R. Di Bartolomeo, and R. Fattori Endovascular treatment for acute traumatic transection of the descending aorta: focus on operative timing and left subclavian artery management. J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1558 - 1563. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Buz, B. Zipfel, S. Mulahasanovic, M. Pasic, Y. Weng, and R. Hetzer Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 143 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Coselli and S. A. LeMaire Descending and Thoracoabdominal Aortic Aneurysms Card. Surg. Adult, January 1, 2008; 3(2008): 1277 - 1298. [Full Text]
|
|
|
|
 |
|
 L. G. Svensson, N. T. Kouchoukos, D. C. Miller, J. E. Bavaria, J. S. Coselli, M. A. Curi, H. Eggebrecht, J. A. Elefteriades, R. Erbel, T. G. Gleason, et al. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts Ann. Thorac. Surg., January 1, 2008; 85(1_Supplement): S1 - S41. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Marcheix, C. Dambrin, J.-P. Bolduc, C. Arnaud, L. Hollington, C. Cron, A. Mugniot, P. Soula, M. Bennaceur, V. Chabbert, et al. Endovascular repair of traumatic rupture of the aortic isthmus: midterm results. J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1037 - 1041. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Sakamoto, T. Hattori, Y. Watanabe, and Y. Sakakibara Chronic post-traumatic pseudoaneurysm of the brachiocephalic artery with tracheal obstruction resulting in repeated pneumonia. Ann. Thorac. Surg., September 1, 2006; 82(3): 1101 - 1103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Fattori, C. A. Nienaber, H. Rousseau, J.-P. Beregi, R. Heijmen, M. Grabenwoger, P. Piquet, L. Lovato, C. Dabbech, S. Kische, et al. Results of endovascular repair of the thoracic aorta with the Talent Thoracic stent graft: The Talent Thoracic Retrospective Registry. J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 332 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Agostinelli, S. Saccani, B. Borrello, F. Nicolini, P. Larini, and T. Gherli Immediate endovascular treatment of blunt aortic injury: Our therapeutic strategy J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1053 - 1057. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Rousseau, C. Dambrin, B. Marcheix, L. Richeux, M. Mazerolles, C. Cron, A. Watkinson, A. Mugniot, P. Soula, V. Chabbert, et al. Acute traumatic aortic rupture: A comparison of surgical and stent-graft repair J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1050 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Bortone, E. De Cillis, D. D'Agostino, and L. d. L. T. Schinosa Endovascular Treatment of Thoracic Aortic Disease: Four Years of Experience Circulation, September 14, 2004; 110(11_suppl_1): II-262 - II-267. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Demers, C. Miller, R. S. Mitchell, S. T. Kee, R.N. L. Chagonjian, and M. D. Dake Chronic traumatic aneurysms of the descending thoracic aorta: mid-term results of endovascular repair using first and second-generation stent-grafts Eur. J. Cardiothorac. Surg., March 1, 2004; 25(3): 394 - 400. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-H. Marty-Ane, J.-P. Berthet, P. Branchereau, H. Mary, and P. Alric Endovascular repair for acute traumatic rupture of the thoracic aorta Ann. Thorac. Surg., June 1, 2003; 75(6): 1803 - 1807. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Zeebregts, J. M. Klaase, and R. H. Geelkerken Endovascular Treatment of Traumatic Thoracic Aortic Rupture Combined with Diaphragmatic Rupture: A Case Report Vascular and Endovascular Surgery, May 1, 2003; 37(3): 219 - 223. [Abstract] [PDF]
|
|
|
|
|
|
R. Karmy-Jones, E. Hoffer, M. Meissner, and R. D. Bloch Management of traumatic rupture of the thoracic aorta in pediatric patients Ann. Thorac. Surg., May 1, 2003; 75(5): 1513 - 1517. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. Roques, J. Remes, M.N. Laborde, J.P. Guibaud, F. Rosato, T. MacBride, and E. Baudet Surgery of chronic traumatic aneurysm of the aortic isthmus: benefit of direct suture Eur. J. Cardiothorac. Surg., January 1, 2003; 23(1): 46 - 49. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. P. Orford, N. R. Atkinson, K. Thomson, P. Y. Milne, W. A. Campbell, A. Roberts, J. Goldblatt, and J. Tatoulis Blunt traumatic aortic transection: the endovascular experience Ann. Thorac. Surg., January 1, 2003; 75(1): 106 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Coselli and P. L. Moreno Descending and Thoracoabdominal Aneurysm Card. Surg. Adult, January 1, 2003; 2(2003): 1169 - 1190. [Full Text]
|
|
|
|
|
|
D. Roux, L. Brouchet, H. Rousseau, T. Elghobary, Y. Glock, and G. Fournial Treatment of a fistula at the distal anastomosis after Bentall operation with endoluminal covered stent Ann. Thorac. Surg., December 1, 2002; 74(6): 2189 - 2190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Bortone, S. Schena, D. D'Agostino, G. Dialetto, V. Paradiso, G. Mannatrizio, T. Fiore, M. Cotrufo, and L. de Luca Tupputi Schinosa Immediate Versus Delayed Endovascular Treatment of Post-Traumatic Aortic Pseudoaneurysms and Type B Dissections: Retrospective Analysis and Premises to the Upcoming European Trial Circulation, September 24, 2002; 106(12_suppl_1): I-234 - I-240. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Leobon, D. Roux, A. Mugniot, H. Rousseau, A. Cerene, Y. Glock, and G. Fournial Endovascular treatment of thoracic aortic fistulas Ann. Thorac. Surg., July 1, 2002; 74(1): 247 - 249. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lachat, T. Pfammatter, H. Witzke, E. Bernard, U. Wolfensberger, A. Kunzli, and M. Turina Acute traumatic aortic rupture: early stent-graft repair Eur. J. Cardiothorac. Surg., June 1, 2002; 21(6): 959 - 963. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. S. Morris Role of Vascular and Interventional Radiology in the Diagnosis and Management of Acute Trauma Patients J Intensive Care Med, May 1, 2002; 17(3): 112 - 126. [Abstract] [PDF]
|
|
|
|
|
|
J. H. Holmes IV, R. D. Bloch, R. A. Hall, Y. M. Carter, and R. C. Karmy-Jones Natural history of traumatic rupture of the thoracic aorta managed nonoperatively: a longitudinal analysis Ann. Thorac. Surg., April 1, 2002; 73(4): 1149 - 1154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Rachel, T. M. Bergamini, E. V. Kinney, M. T. Jung, H. W. Kaebnick, and R. A. Mitchell Endovascular Repair of Thoracic Aortic Aneurysms: A Paradigm Shift in Standard of Care Vascular and Endovascular Surgery, March 1, 2002; 36(2): 105 - 113. [Abstract] [PDF]
|
|
|
|
|
|
T. Langanay, J.-P. Verhoye, H. Corbineau, A. Agnino, T. Derieux, P. Menestret, Y. Logeais, and A. Leguerrier Surgical treatment of acute traumatic rupture of the thoracic aorta a timing reappraisal? Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 282 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.S. Bortone, S. Schena, G. Mannatrizio, V. Paradiso, G. Ferlan, G. Dialetto, M. Cotrufo, and L. de Luca Tupputi Schinosa Endovascular stent-graft treatment for diseases of the descending thoracic aorta Eur. J. Cardiothorac. Surg., September 1, 2001; 20(3): 514 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Dorweiler, C. Dueber, A. Neufang, W. Schmiedt, M.B. Pitton, and H. Oelert Endovascular treatment of acute bleeding complications in traumatic aortic rupture and aortobronchial fistula Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 739 - 745. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Razzouk, S. R. Gundry, N. Wang, M. J. del Rio, D. Varnell, and L. L. Bailey Repair of Traumatic Aortic Rupture: A 25-Year Experience Arch Surg, August 1, 2000; 135(8): 913 - 918. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Doenst, C. Schlensak, F. Beyersdorf, H. Rousseau, B. Janne d’Othee, P. Perreault, G. Meites, F. Joffre, P. Otal, P. Soula, et al. Limitations to the Therapeutic Potential of Endoluminal Stent Placement in the Thoracic Aorta • Response Circulation, March 14, 2000; 101 (10): e96 - e96. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||