J Korean Med Sci.  2010 Jan;25(1):142-144. 10.3346/jkms.2010.25.1.142.

Hybrid Procedure for a Traumatic Aortic Rupture Consisting of Endovascular Repair and Minimally Invasive Arch Vessel Transposition without Sternotomy

• Ryu YG
• Choo SJ
• Lim JY
• Yoon HK
• Chung CH

• KMID: 1713845
• DOI: http://doi.org/10.3346/jkms.2010.25.1.142

Abstract

Emergency surgical repair for acute traumatic aortic ruptures has been associated with a high peri-procedural mortality rate. Endovascular stent-grafting, as a less invasive procedure, has shown encouraging results. This report describes a patient with a short landing zone, who was treated by transposing the supra-aortic branch without sternotomy, followed by covered stent-grafting with an extended proximal bare portion to enhance fixation.

Keyword

Aorta; Wounds and Injuries; Stent-graft

MeSH Terms

Acute Disease
Aged
Aortic Rupture/diagnosis/radiography/*surgery
Female
Humans
Stents
Sternotomy
Subclavian Artery
Surgical Procedures, Minimally Invasive
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Preoperative CT scan showing an extraluminal hematoma of the distal aortic arch containing an aortic rupture.

• 

  Fig. 2 (A) Pre-procedural angiogram after debranching of the left subclavian artery, showing free blood flow to both arch vessels and the morphology and extent of the rupture site. Post-procedural angiogram (B) and CT scan (C) after stent-graft placement, showing complete exclusion of the rupture site and good apposition of the endoprosthesis, without endoleak around A B C the stent-graft.

• 

  Fig. 3 Left supraclavicular wound.

Reference

1. Rousseau H, Dambrin C, Marcheix B, Richeux L, Mazerolles M, Cron C, Watkinson A, Mugniot A, Soula P, Chabbert V, Canevet G, Roux D, Massabuau P, Meites G, Tran Van T, Otal P. Acute traumatic aortic rupture: a comparison of surgical and stent graft repair. J Thorac Cardiovasc Surg. 2005. 129:1050–1055.

2. Kuhne CA, Ruchholtz S, Voggenreiter G, Eggebrecht H, Paffrath T, Waydhas C, Nast-Kolb D, AG Polytrauma DGU. Traumatic aortic injuries in severely injured patients. Unfallchirurg. 2005. 108:279–287.

3. Jahromi AS, Kazemi K, Safar HA, Doobay B, Cina CS. Traumatic aortic rupture of the thoracic aorta: cohort study and systematic review. J Vasc Surg. 2001. 34:1029–1034.

4. von Oppell UO, Dunne 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.

5. Morgan R, Loosemore T, Belli AM. Endovascular repair of contained rupture of the thoracic aorta. Cardiovasc Intervent Radiol. 2002. 25:291–294.

6. Wellons ED, Milner R, Solis M, Levitt A, Rosenthal D. Stent-graft repair of traumatic aortic disruptions. J Vasc Surg. 2004. 40:1095–1100.

7. Buz S, Zipfel B, Mulahasanovic S, Pasic M, Weng Y, Hetzer R. Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture. Eur J Cardiothorac Surg. 2008. 33:143–149.

8. Doss M, Wood JP, Balzer J, Martens S, Deschka H, Moritz A. Emergency endovascular interventions for acute thoracic aortic rupture: four-year follow-up. J Thorac Cardiovasc Surg. 2005. 129:645–651.

9. Buth J, Harris PL, Hobo R, van Eps R, Cuypers P, Duijm L, Tielbeek X. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repai (EUROSTAR) registry. J Vasc Surg. 2007. 46:1103–1110.