Background. Thoracic aortic transection resulting from blunt trauma is usually fatal. It is almost always associated with multiple, complex, nonaortic injuries that could be adversely affected by standard surgical repair of the aorta. Endovascular stenting techniques offer these patients a less physiologically disruptive treatment option. We studied the feasibility and safety of endovascular stent graft placement for treatment of acute traumatic aortic transection. Methods. Between 1994 and 2001, 9 patients were treated emergently for aortic transections with stent graft placement. The first patient had a custom-made prototype, and the other 8 patients had the Cook-Zenith thoracic stent graft implanted. All were polyester-covered Z-stent construction and deployed through a femoral 20- to 24-F delivery sheath. Results. Stent graft placement successfully sealed the aorta in all patients. One patient died as a result of a cerebrovascular accident. One patient required a brachial thrombectomy to relieve arm ischemia. The remaining eight patients were alive and without complications during the follow-up period (mean 21 months). Conclusions. Endovascular repair for acute aortic transection is a safe, effective, and timely treatment option. It may be the treatment of choice in patients with extensive associated injuries.
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The first patient in our series had a history of previous pleurodesis. Open repair through a thoracotomy was attempted and abandoned because of extensive adhesions and poor access to the aorta. He subsequently had a bridging Palmaz stent (Cordis, NJ) placed for signs of developing aortic obstruction. The contained false aneurysm remained stable, perhaps supported by the periaortic adhesions from the past pleurodesis. A prototype, covered stent graft was then constructed by Dr. Michael Dake of Stanford University Medical Center, Palo Alto, California, and implanted 27 days later.