Acute Aortic Disease.. - Index of

Endovascular Thoracic Aortic Stent Grafting 289
positioning, single lung ventilation for thoracotomy, or injuries precluding systemic
heparinization.
Due to the significant morbidity and mortality associated with surgical
repair of traumatic aortic injury in this group of severely injured patients, there has
been a growing interest in the emergent treatment of traumatic aortic transection
with TEVAR (Fig. 10). The minimally invasive approach of TEVAR offers these
often severely injured patients a less morbid intervention.
Reed and coworkers recently reviewed their experience with traumatic
transections over a 5-year period from 2000–2005. A total of 51 patients presented
with the diagnosis of traumatic transection. Twenty-seven (52%) patients died
before intervention. Of the remaining 24 patients, nine patients underwent
emergent conventional open repair. Thirteen patients underwent delayed TEVAR,
with the mean duration from diagnosis to treatment of 6 days. Technical success
with complete exclusion of the transection was achieved in all 13 patients. Thirtyday
mortality was 23% (n = 3) (74).
Multiple small series have demonstrated that TEVAR in the acute setting
for traumatic transections can be performed with excellent technical success and
acceptable perioperative morbidity and mortality, when compared to conventional
open repair. Tehrani et al. (75) reported their experience of 30 patients with traumatic
aortic and severe concomitant nonaortic injuries treated with TEVAR.
Technical success was 100% with angiographic evidence of complete exclusion
of the disruption. There were two peri-procedural deaths and no incidence of paraplegia.
With a mean follow-up of 11.6 months, there was no evidence of endoleak,
stent migration, or late pseudoaneurysm formation. Other smaller series have
demonstrated similar findings, with a mean follow-up period up to 21 months
(21,67,76,77,100). Peri-procedural mortality rates range from 0% to 11%, with no
incidence of paraplegia. All endovascular stent graft deployment was performed
Figure 10 Thoracic endovascular aortic repair of traumatic transection (white arrow).