Thoracic Endovascular Stent Graft Repair (TEVAR) for Acute Traumatic Transection of the Descending Thoracic Aorta

초록

Background : Most blunt traumatic aortic injuries occur in the proximal descending thoracic aorta, and it results in moribund disaster. Classically open surgical repair with left heart bypass was treatment of choice. Recently developed TEVAR seems to be a good alternative treatment. We reviewed our experience of TEVAR for acute traumatic transection of aorta. Methods : From 2009 to 2015, 13 patients (11 males and 2 females) were referred to our department with diagnosis of acute transection of thoracic aorta. Age was 47±14 years. All patients had associated injuries such as multiple rib fractures, lung contusion, hemothorax, and hemoperitoneum. TEVAR was done emergently under general endotracheal induction. Follow-up Computed Tomography(CT) was done 1 week, 6 months and yearly thereafter. Results : All patients undergone TEAVR achieved 100% technical success, which showed complete sealing of the transected aorta in final aortogram. A patient was died. The cause of death was hypovolemic shock from multi-organ trauma including liver, spleen, pelvic bone. Complete left subclavian coverage was done in 5 patients without carotid subclavian bypass, who showed no left arm problems. ARDS including Pneumonia was developed in two patients. All 12 patients who were survived had no aorta related event for 47 months ± 34 months of outpatient follow-up period. There was no endoleak in CT follow up at mean 26 months. Conclusion : Despite small number of patient population, TEVAR for acute traumatic aortic transection provide excellent mid-term results.