Endovascular treatment of traumatic injuries of thoracic aorta

Abstract

Background. The aim of this paper is the evaluation of endovascular treatment of traumatic injuries of the thoracic aorta.
Material and methods. In the years 2003-2005, 13 patients were treated for traumatic injuries of the descending aorta related to traffic accidents. The types of traumatic lesions of the aorta were determined according to contrast-enhanced computed tomography (CT). This imaging also allowed the determination of the parameters necessary for stentgraft implantation, as well as possible injuries of other internal organs. In 12 patients, the procedure was performed through common femoral artery access; in one case, the stentgraft was introduced through a Dacron prosthesis sutured to the abdominal aorta. In nine cases, the stentgraft was implanted just below the origin of the left subclavian artery, and in four cases, below the origin of the left common carotid artery occluding the origin of the subclavian artery.
Results. In six patients, post-traumatic pseudoaneurysm of the thoracic aorta was diagnosed, aortic rupture with blood extravasation into mediastinum and pleural cavities in four others; whereas, in the three subsequent patients, type B aortic dissection was diagnosed. In all cases a good short-term treatment outcome was achieved along with the patient’s stable condition.
Conclusions. Endovascular treatment involving stentgraft implantation is a safe and rapid method of treatment for traumatic injuries of the descending aorta. In the case of injury to the higher portion of the aorta, occlusion of the origin of the left subclavian artery is possible without secondary symptoms of ischaemia of CNS and/or left upper limb.