Delayed treatment of traumatic rupture of the thoracic aorta with endoluminal covered stent

Background-Stent grafting is emerging as a new treatment for several pathol ogical conditions involving the thoracic aorta. We studied the feasibility and safety of this technique for delayed treatment of ruptures of the aorti c isthmus. Methods and Results-Nine patients (14 to 76 years old; mean, 37 years; male /female ratio, 8/1) underwent stent grafting of the aortic isthmus in subac ute (n=5) or chronic (n=4) aortic traumatic rupture after a motor accident, In subacute ruptures, this treatment was delayed (1 to 8 months; mean, 5.4 months) because of the severity of other associated injuries. Stent grafti ng was technically successful (defined as complete exclusion of the pseudoa neurysmal sac) in all patients. Short-term fever and biological inflammator y syndrome occurred in 3 patients. Two major complications occurred: in 1 p atient, an early occlusion of the left subclavian artery was treated by pla cement of 2 Palmaz stents, In another patient, an atelectasis related to an increase of preexisting compression of the left main bronchus by the pseud oaneurysmal sac was successfully treated by temporary placement of an endob ronchial silicone stent. Mean follow-up was 11.6 months (range, 3 to 21 mon ths). Thrombosis of the pseudoaneurysmal sac was found in all patients. Conclusions-In the absence of available extended follow-up about the safety and effectiveness of endovascular grafting, this approach seems to be a vi able therapeutic option for traumatic rupture of the aortic isthmus, but ap propriately controlled prospective studies are needed before we can recomme nd its widespread use.