Endovascular Treatment of Traumatic Thoracic Aortic Injuries: Short- and Medium-term Follow-up

Background Successful thoracic endovascular aortic repair (TEVAR) with low rates of complications has been referred to in the treatment of traumatic thoracic aortic injuries; however, we still do not know the long-term behavior. In this series, short- and intermediate-term results of TEVAR of trauma...

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Veröffentlicht in:Annals of vascular surgery 2010-02, Vol.24 (2), p.160-166
Hauptverfasser: Fernandez, Valentín, Mestres, Gaspar, Maeso, Jordi, Domínguez, José Manuel, Aloy, M. Carmen, Matas, Manel
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container_end_page 166
container_issue 2
container_start_page 160
container_title Annals of vascular surgery
container_volume 24
creator Fernandez, Valentín
Mestres, Gaspar
Maeso, Jordi
Domínguez, José Manuel
Aloy, M. Carmen
Matas, Manel
description Background Successful thoracic endovascular aortic repair (TEVAR) with low rates of complications has been referred to in the treatment of traumatic thoracic aortic injuries; however, we still do not know the long-term behavior. In this series, short- and intermediate-term results of TEVAR of traumatic aortic injuries are analyzed. Methods The clinical charts and courses of 20 patients (mean age, 31.8 years; age range, 15-65 years; 14 [70%] men) with traumatic thoracic aortic injuries treated with TEVAR were retrospectively reviewed. Mean delay from trauma to intervention was 15 days (range, 0-180 days). Results The initial success rate was 100%, with no deaths or intraoperative leaks, although in 4 (20%) patients, injuries were repaired in the arterial access site. The mean postoperative follow-up was 43.53 months (range, 5.5-108.0 months). Four (20%) patients required reintervention: 2 postoperative revascularizations of the left subclavian artery (20% of the patients in whom the ostium was intentionally occluded) and 2 aortic reinterventions (endovascular treatment of a collapsed stent graft and open repair after thrombosis of another stent graft). All reinterventions were successfully performed and no additional complications were registered during follow-up. Asymptomatic findings related to the stent graft included lack of proximal device-wall apposition in 8 patients (40%), intragraft mural thrombus formation during the first 6 months in 7 patients (35%), and an asymptomatic fracture of the longitudinal reinforcing bar of the stent graft 4 years later in 1 patient (5%). Conclusion Although not completely exempt of complications, TEVAR provides a reliable method for the treatment of traumatic thoracic aortic injuries with good results in the short- and medium-term follow-up. All complications have been treated successfully. Long-term evolution of lack of proximal device-wall apposition and intragraft mural thrombus formation should be closely monitored to prevent long-term complications.
doi_str_mv 10.1016/j.avsg.2009.05.013
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The mean postoperative follow-up was 43.53 months (range, 5.5-108.0 months). Four (20%) patients required reintervention: 2 postoperative revascularizations of the left subclavian artery (20% of the patients in whom the ostium was intentionally occluded) and 2 aortic reinterventions (endovascular treatment of a collapsed stent graft and open repair after thrombosis of another stent graft). All reinterventions were successfully performed and no additional complications were registered during follow-up. Asymptomatic findings related to the stent graft included lack of proximal device-wall apposition in 8 patients (40%), intragraft mural thrombus formation during the first 6 months in 7 patients (35%), and an asymptomatic fracture of the longitudinal reinforcing bar of the stent graft 4 years later in 1 patient (5%). Conclusion Although not completely exempt of complications, TEVAR provides a reliable method for the treatment of traumatic thoracic aortic injuries with good results in the short- and medium-term follow-up. All complications have been treated successfully. Long-term evolution of lack of proximal device-wall apposition and intragraft mural thrombus formation should be closely monitored to prevent long-term complications.</description><identifier>ISSN: 0890-5096</identifier><identifier>EISSN: 1615-5947</identifier><identifier>DOI: 10.1016/j.avsg.2009.05.013</identifier><identifier>PMID: 19900782</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - injuries ; Aorta, Thoracic - surgery ; Aortography - methods ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Female ; Humans ; Male ; Middle Aged ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Stents ; Surgery ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Wounds and Injuries - diagnostic imaging ; Wounds and Injuries - surgery ; Young Adult</subject><ispartof>Annals of vascular surgery, 2010-02, Vol.24 (2), p.160-166</ispartof><rights>Annals of Vascular Surgery Inc.</rights><rights>2006 Annals of Vascular Surgery Inc.</rights><rights>Copyright 2006 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c476t-9403241fcfed14d792ed7cca7360fd2896ee4487028c2d56a6bb5e05caa417f53</citedby><cites>FETCH-LOGICAL-c476t-9403241fcfed14d792ed7cca7360fd2896ee4487028c2d56a6bb5e05caa417f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.avsg.2009.05.013$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19900782$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fernandez, Valentín</creatorcontrib><creatorcontrib>Mestres, Gaspar</creatorcontrib><creatorcontrib>Maeso, Jordi</creatorcontrib><creatorcontrib>Domínguez, José Manuel</creatorcontrib><creatorcontrib>Aloy, M. Carmen</creatorcontrib><creatorcontrib>Matas, Manel</creatorcontrib><title>Endovascular Treatment of Traumatic Thoracic Aortic Injuries: Short- and Medium-term Follow-up</title><title>Annals of vascular surgery</title><addtitle>Ann Vasc Surg</addtitle><description>Background Successful thoracic endovascular aortic repair (TEVAR) with low rates of complications has been referred to in the treatment of traumatic thoracic aortic injuries; however, we still do not know the long-term behavior. In this series, short- and intermediate-term results of TEVAR of traumatic aortic injuries are analyzed. Methods The clinical charts and courses of 20 patients (mean age, 31.8 years; age range, 15-65 years; 14 [70%] men) with traumatic thoracic aortic injuries treated with TEVAR were retrospectively reviewed. Mean delay from trauma to intervention was 15 days (range, 0-180 days). Results The initial success rate was 100%, with no deaths or intraoperative leaks, although in 4 (20%) patients, injuries were repaired in the arterial access site. The mean postoperative follow-up was 43.53 months (range, 5.5-108.0 months). Four (20%) patients required reintervention: 2 postoperative revascularizations of the left subclavian artery (20% of the patients in whom the ostium was intentionally occluded) and 2 aortic reinterventions (endovascular treatment of a collapsed stent graft and open repair after thrombosis of another stent graft). All reinterventions were successfully performed and no additional complications were registered during follow-up. Asymptomatic findings related to the stent graft included lack of proximal device-wall apposition in 8 patients (40%), intragraft mural thrombus formation during the first 6 months in 7 patients (35%), and an asymptomatic fracture of the longitudinal reinforcing bar of the stent graft 4 years later in 1 patient (5%). Conclusion Although not completely exempt of complications, TEVAR provides a reliable method for the treatment of traumatic thoracic aortic injuries with good results in the short- and medium-term follow-up. All complications have been treated successfully. 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Carmen</creator><creator>Matas, Manel</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100201</creationdate><title>Endovascular Treatment of Traumatic Thoracic Aortic Injuries: Short- and Medium-term Follow-up</title><author>Fernandez, Valentín ; Mestres, Gaspar ; Maeso, Jordi ; Domínguez, José Manuel ; Aloy, M. Carmen ; Matas, Manel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c476t-9403241fcfed14d792ed7cca7360fd2896ee4487028c2d56a6bb5e05caa417f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - injuries</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortography - methods</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prosthesis Failure</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Wounds and Injuries - diagnostic imaging</topic><topic>Wounds and Injuries - surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fernandez, Valentín</creatorcontrib><creatorcontrib>Mestres, Gaspar</creatorcontrib><creatorcontrib>Maeso, Jordi</creatorcontrib><creatorcontrib>Domínguez, José Manuel</creatorcontrib><creatorcontrib>Aloy, M. 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Carmen</au><au>Matas, Manel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endovascular Treatment of Traumatic Thoracic Aortic Injuries: Short- and Medium-term Follow-up</atitle><jtitle>Annals of vascular surgery</jtitle><addtitle>Ann Vasc Surg</addtitle><date>2010-02-01</date><risdate>2010</risdate><volume>24</volume><issue>2</issue><spage>160</spage><epage>166</epage><pages>160-166</pages><issn>0890-5096</issn><eissn>1615-5947</eissn><abstract>Background Successful thoracic endovascular aortic repair (TEVAR) with low rates of complications has been referred to in the treatment of traumatic thoracic aortic injuries; however, we still do not know the long-term behavior. In this series, short- and intermediate-term results of TEVAR of traumatic aortic injuries are analyzed. Methods The clinical charts and courses of 20 patients (mean age, 31.8 years; age range, 15-65 years; 14 [70%] men) with traumatic thoracic aortic injuries treated with TEVAR were retrospectively reviewed. Mean delay from trauma to intervention was 15 days (range, 0-180 days). Results The initial success rate was 100%, with no deaths or intraoperative leaks, although in 4 (20%) patients, injuries were repaired in the arterial access site. The mean postoperative follow-up was 43.53 months (range, 5.5-108.0 months). Four (20%) patients required reintervention: 2 postoperative revascularizations of the left subclavian artery (20% of the patients in whom the ostium was intentionally occluded) and 2 aortic reinterventions (endovascular treatment of a collapsed stent graft and open repair after thrombosis of another stent graft). All reinterventions were successfully performed and no additional complications were registered during follow-up. Asymptomatic findings related to the stent graft included lack of proximal device-wall apposition in 8 patients (40%), intragraft mural thrombus formation during the first 6 months in 7 patients (35%), and an asymptomatic fracture of the longitudinal reinforcing bar of the stent graft 4 years later in 1 patient (5%). Conclusion Although not completely exempt of complications, TEVAR provides a reliable method for the treatment of traumatic thoracic aortic injuries with good results in the short- and medium-term follow-up. All complications have been treated successfully. Long-term evolution of lack of proximal device-wall apposition and intragraft mural thrombus formation should be closely monitored to prevent long-term complications.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>19900782</pmid><doi>10.1016/j.avsg.2009.05.013</doi><tpages>7</tpages></addata></record>
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subjects Adolescent
Adult
Aged
Aorta, Thoracic - diagnostic imaging
Aorta, Thoracic - injuries
Aorta, Thoracic - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - instrumentation
Female
Humans
Male
Middle Aged
Prosthesis Failure
Reoperation
Retrospective Studies
Stents
Surgery
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Wounds and Injuries - diagnostic imaging
Wounds and Injuries - surgery
Young Adult
title Endovascular Treatment of Traumatic Thoracic Aortic Injuries: Short- and Medium-term Follow-up
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