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Emergency stent-graft placement for hemorrhage control in acute thoracic aortic rupture

Melnitchouk, Serguei ; Pfammatter, Thomas ; Kadner, Alexander ; Dave, Hitendu ; Witzke, Herbert ; Trentz, Otmar ; Turina, Marko ; Lachat, Mario

In: European Journal of Cardio-Thoracic Surgery, 2004, vol. 25, no. 6, p. 1032-1038

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    Title
    • Emergency stent-graft placement for hemorrhage control in acute thoracic aortic rupture
    Author
    • Melnitchouk, Serguei. Clinic for Cardiovascular Surgery at Zurich University Hospital, Zurich, Switzerland
    • Pfammatter, Thomas. Department of Radiology at Zurich University Hospital, Zurich, Switzerland
    • Kadner, Alexander. Clinic for Cardiovascular Surgery at Zurich University Hospital, Zurich, Switzerland
    • Dave, Hitendu. Clinic for Cardiovascular Surgery at Zurich University Hospital, Zurich, Switzerland
    • Witzke, Herbert. Clinic for Cardiovascular Surgery at Zurich University Hospital, Zurich, Switzerland
    • Trentz, Otmar. Department of Trauma Surgery at Zurich University Hospital, Zurich, Switzerland
    • Turina, Marko. Clinic for Cardiovascular Surgery at Zurich University Hospital, Zurich, Switzerland
    • Lachat, Mario. Clinic for Cardiovascular Surgery at Zurich University Hospital, Zurich, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • European Journal of Cardio-Thoracic Surgery, 2004, vol. 25, no. 6, p. 1032-1038. Elsevier Science B.V.
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:295470
    Summary
    Objective: To report mid-term results of stent-graft (SG) implantation in acute thoracic aortic rupture as alternative to conventional open surgery with its associated high morbidity and mortality rates. Methods: Out of a series of 69 patients undergoing thoracic aortic SG implantation since 1998, 24 (mean age 57±19 years, range 20-85-years-old) patients were treated on an emergency basis for hemorrhage control. The indication for SG placement was acute traumatic aortic rupture in 15 patients, type B dissection with contained rupture in 3 patients, penetrating aortic ulcer with periaortic hematoma in 3 patients, and thoracic aortic aneurysm rupture in 3 patients. Preoperative assessment was done by computed tomography (CT) scanning and echography. Patients were treated in the angiography suite by implantation of Excluder (n=18), Talent (n=4), Corvita (n=1), and Vanguard (n=1) self-expanding grafts. Local anesthesia was the most frequently used anaesthesiologic technique. Results: Technical success rate of SG deployment was 100%. The early postoperative mortality was 12.5% (3 of 24). One patient suffered temporary paraplegia (4%). There was no intervention-related mortality during the mean follow-up of 34.1 months. Two secondary endoleaks were successfully treated with additional SG placement at 2 and 12 months postoperative, respectively. Conclusions: Emergency SG repair to control hemorrhage in patients with an acute thoracic aortic rupture is a less-invasive attractive and rational treatment option, especially if associated lesions or co-morbidity may interfere with the surgical outcome. Long-term follow-up results will be helpful to clarify procedure durability bounded by material failure and postoperative aneurysm or aortic wall remodelling