TRANSLUMINALLY PLACED ENDOVASCULAR STENTED GRAFT REPAIR FOR ARTERIAL TRAUMA

Purpose: Intravascular stents have become important tools for the mana gement of vascular lesions; however, stents in combination with vascul ar grafts have only recently reached clinical application. This report describes an experience with stented grafts for the treatment of pene trating arterial trauma. Methods: Seven transluminally placed stented grafts were used to treat one arteriovenous fistula and six pseudoaneu rysms. These grafts were successfully inserted percutaneously or throu gh op;en arteriotomies that were remote from the site of vascular trau ma. The devices were composed of balloon-expandable stainless steel st ents covered with polytetrafluoroethylene grafts. Results: Patency up to 14 months was achieved (mean follow-up 6.5 months) with these stent ed grafts. The use of stented grafts appears to be associated with dec reased blood loss, a less invasive insertion procedure, reduced requir ements for anesthesia, and a limited need for an extensive dissection in the traumatized field. These advantages are particularly important in patients with central arteriovenous fistulas or false aneurysms who are critically ill from other coexisting injuries or medical comorbid ities. Conclusions: The use of stented grafts already appears justifie d to treat traumatic arterial lesions in critically ill patients. Alth ough the early results with the seven cases in this report are encoura ging, documentation of long-term effectiveness must be obtained before these devices can be recommended for widespread or generalized use in the treatment of major arterial injuries.