Impact of stent-graft development on outcome of endovascular repair of acute traumatic transection of the thoracic aorta.

PURPOSE

To analyze the impact of stent-graft design on the outcome of endovascular repair of acute traumatic thoracic aortic transection.

METHODS

Forty-eight patients (38 men; mean age 37 ± 11 years) underwent endovascular repair for an acute traumatic aortic rupture between April 2001 and March 2011. Up to October 2007, 32 patients (mean age 41 ± 16 years; group 1) were treated with the first generation of commercially available thoracic stent-grafts (10 Talent, 20 Excluder/TAG, 2 Zenith). From November 2007, 16 patients (mean age 42 ± 19 years; group 2) were treated with second-generation thoracic stent-grafts (13 Valiant and 3 C-TAG). The 2 groups were statistically comparable. Follow-up computed tomography was performed at 1 week; at 3 and 6 months; and annually thereafter.

RESULTS

In the 2 groups, the mortality rate related to aortic repair was nil. All the patients have completed each of their scheduled follow-up evaluations and CT scans. The morbidity rate was significantly reduced (p = 0.0003) from 18.7% (first generation) to 6.2% (second generation). Type I endoleak (n = 1), inadvertent coverage of the supra-aortic trunks (n = 3), and stent-graft collapse (n = 2) occurred only with the first-generation stent-grafts. One iliac artery rupture occurred with a second-generation stent-graft.

CONCLUSION

Enhanced stent-graft conformability and more accurate delivery systems have significantly decreased the morbidity of endovascular repair of acute traumatic transection of the thoracic aorta. The increasing clinical experience may also have contributed to improved results.