Use of endoluminal stent-grafts in acute aortic rupture

Purpose: To report our experience with stent-graft treatment of acute aortic injuries. Materials and methods: Emergent stent-graft placement was considered in patients with acute aortic rupture or injury who were deemed to be high-risk candidates for surgery. After medical stabilization, patients were evaluated for suitability for endovascular interventions. Anatomic criteria for stent-grafting included: (1) contained ruptures of the thoracic aorta located distal to the left subclavian artery and above the celiac axis, and (2) a proximal and distal neck of ≥ 15 mm in length and ≤ 40 mm in diameter. Stent-grafts consisted of a modified Z-stent endoskeleton covered with woven polyester vascular graft material. All devices were placed under general endotracheal anesthesia. A transfemoral approach was utilized if the iliofemoral artery diameter was ≥ 8 mm. For iliofemoral diameters < 8 mm, the catheters were inserted directly into the infrarenal aorta after a retroperitoneal exposure. Patient follow-up consisted of angiography and spiral CT scan prior to discharge from the hospital. Subsequent spiral CT studies were performed at 6 and 12 months, and at 1-year intervals thereafter. Results: Thirteen patients (11 men and 2 women) with a mean age of 60 years (range 34-81 years) underwent emergent placement of thoracic stent-grafts for acute aneurysmal rupture (n = 8), traumatic transection (n = 3), or tumor and abscess erosions (n = 2). The stent-grafts were deployed successfully in all cases and there were no cases of embolization, paraplegia, or stent-graft migration. No patient required surgical conversion. The average stent-graft dimension was 34 mm in diameter (range 24-38 mm) by 15.8 cm in length (range 5.0-17.5 cm). No patient with traumatic aortic injury was excluded on the basis of anatomic criteria. Two patients died within 1 month of the procedure, one of ventricular rupture and the other of cardiac arrest on day 28 after an uneventful hospital course for a ruptured aneurysm. Conclusion: The primary experience from our series demonstrates that aortic stent-grafting for traumatic aortic injury is technically feasible and can be used to treat thoracic aortic rupture in patients at high risk for standard operative therapy.