Acute Aortic Disease.. - Index of

290 Brinster et al.
using no (or low dose) heparin. Stroke was rare with only one series reporting a
single patient suffering a cerebrovascular accident (76).
In summary, TEVAR for traumatic transection appears to be a surgical alternative
with morbidity and mortality rates similar to conventional open surgical
repair. The most useful application of endovascular technology appears to be
for patients with concomitant severe nonaortic blunt injuries who would otherwise
be denied surgical repair of the aortic injury. However, TEVAR in this group
of severely injured patients may not significantly improve overall survival,
as these patients may eventually succumb to their associated nonaortic traumatic
injuries. More evidence and long-term follow-up will be needed before definitive
conclusions can be drawn.
Rupture (Aneurysmal)
Although ruptured descending thoracic aortic aneurysm is relatively uncommon
compared to ruptured AAA, the complication and mortality rates are equally
devastating. Mortality rates for emergent open repair of descending thoracic
aortic aneurysms approach 70% and the associated paraplegia rates are about
20% (55,78,79).
TEVAR offers several potential advantages over conventional surgical
repair. These advantages include the avoidance of thoracotomy and single lung
ventilation, avoidance of aortic cross clamping, decreased blood loss, shorter
operative time, and the avoidance of systemic heparinization and cardiopulmonary
bypass (CPB). Recent reports confirm an emerging role for TEVAR in this population
of patients (Fig. 11).
Recently, Leurs and coworkers reported the European experience
(EUROSTAR Registry) with TEVAR for thoracic aortic aneurysms and dissections.
From 1997 to 2003, 443 patients underwent TEVAR for thoracic aortic diseases.
Figure 11 Successful stenting of ruptured aneurysm (white arrow).