ENDOVASCULAR MANAGEMENT OF TRAUMATIC INFRARENAL ABDOMINAL AORTIC DISSECTION

Dissection is a recognized finding after blunt trauma to the abdominal aorta. immediate and long-term prognosis is poor without surgical tre atment especially since most patients present severe associated injuri es. On the basis of encouraging results using endovascular techniques to treat experimental dissection of the descending thoracic aorta, we treated three patients with traumatic infrarenal abdominal aortic diss ection by percutaneous stent placement. There were two men 34 and 41 y ears of age and one 89-year-old woman. In all patients, dissection beg an in the infrarenal portion of the aorta and extended into the iliac arteries. All patients had multiple associated injuries. The main symp toms were acute abdominal pain (two patients) and ischemia of the lowe r extremities (two patients). Diagnosis was missed in one patient desp ite exploratory laparotomy for an associated injury. Two patients were treated in the acute phase by placement of a self-expanding endovascu lar prosthesis at the aortoiliac level. The third patient was treated in the chronic phase by placement of a balloon-expandable endovascular stent. All procedures were performed uneventfully by femoral route. S uccess of treatment was confirmed by arteriography and computed tomogr aphy (CT) scan demonstrating obliteration of the dissection. Upon late follow-up examination, all patients were in satisfactory condition, w ith normal Doppler ultrasound findings. These findings confirm experim ental studies using endovascular treatment for dissection of the desce nding thoracic aorta and are promising for future clinical management.