Indications for, timing of, and results of catheter-based treatment of traumatic injury to the aorta

Rossella Fattori, Gabriella Napoli, Luigi Lovato, Vincenzo Russo, Davide Pacini, Angelo Pierangeli, Giampaolo Gavelli

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

OBJECTIVE. The optimal treatment for and timing of surgery to repair traumatic aortic injury are still controversial. Endovascular treatment is a viable option in patients with both acute and chronic aortic trauma. However, appropriate patient selection criteria, treatment timing, and long-term durability of endovascular repair remain to be defined. We sought to identify appropriate selection criteria and optimal timing of treatment as well as to assess the long-term durability of endovascular repair. SUBJECTS AND METHODS. From July 1997 to December 2001, 19 patients with traumatic aortic injury (11 patients with acute and eight with chronic injuries) were selected for endovascular treatment. In all patients, the lesions were sited at the proximal segment of the descending aorta at a distance of 10 ± 17 mm (mean ± SD) from the left subclavian artery. Nine of the patients with acute injuries were treated after clinical stabilization of other severe associated lesions, whereas two patients, in whom hemodynamic and imaging findings suggested an impending rupture, received emergency treatment. Single-detector helical CT or MR imaging was used for patient selection and stent-graft customization before treatment and for evaluation of patients during the follow-up period. RESULTS. Endovascular stent positioning was successful in all patients. None of the patients developed complications. Aneurysm exclusion and shrinkage were confirmed at follow-up examinations. A partial covering of the subclavian artery occurred in six patients without interrupting the blood flow. All patients remain asymptomatic after a mean follow-up period of 20 months (range, 1-56 months). CONCLUSION. Endovascular repair represents an alternative, minimally invasive treatment, particularly suitable for use in patients with traumatic aortic injuries. The decision of whether to provide immediate emergency treatment or to delay treatment should be based on the lesion characteristics on imaging and clinical findings. The durability of treatment seems to be related to the absence of alteration to the aortic wall at the extremities.

Original languageEnglish
Pages (from-to)603-609
Number of pages7
JournalAmerican Journal of Roentgenology
Volume179
Issue number3
Publication statusPublished - Sep 2002

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Aorta
Catheters
Wounds and Injuries
Patient Selection
Therapeutics
Subclavian Artery
Emergency Treatment
Stents
Spiral Computed Tomography
Thoracic Aorta
Aneurysm
Rupture
Extremities
Hemodynamics
Transplants

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Fattori, R., Napoli, G., Lovato, L., Russo, V., Pacini, D., Pierangeli, A., & Gavelli, G. (2002). Indications for, timing of, and results of catheter-based treatment of traumatic injury to the aorta. American Journal of Roentgenology, 179(3), 603-609.

Indications for, timing of, and results of catheter-based treatment of traumatic injury to the aorta. / Fattori, Rossella; Napoli, Gabriella; Lovato, Luigi; Russo, Vincenzo; Pacini, Davide; Pierangeli, Angelo; Gavelli, Giampaolo.

In: American Journal of Roentgenology, Vol. 179, No. 3, 09.2002, p. 603-609.

Research output: Contribution to journalArticle

Fattori, R, Napoli, G, Lovato, L, Russo, V, Pacini, D, Pierangeli, A & Gavelli, G 2002, 'Indications for, timing of, and results of catheter-based treatment of traumatic injury to the aorta', American Journal of Roentgenology, vol. 179, no. 3, pp. 603-609.
Fattori R, Napoli G, Lovato L, Russo V, Pacini D, Pierangeli A et al. Indications for, timing of, and results of catheter-based treatment of traumatic injury to the aorta. American Journal of Roentgenology. 2002 Sep;179(3):603-609.
Fattori, Rossella ; Napoli, Gabriella ; Lovato, Luigi ; Russo, Vincenzo ; Pacini, Davide ; Pierangeli, Angelo ; Gavelli, Giampaolo. / Indications for, timing of, and results of catheter-based treatment of traumatic injury to the aorta. In: American Journal of Roentgenology. 2002 ; Vol. 179, No. 3. pp. 603-609.
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AU - Pacini, Davide

AU - Pierangeli, Angelo

AU - Gavelli, Giampaolo

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N2 - OBJECTIVE. The optimal treatment for and timing of surgery to repair traumatic aortic injury are still controversial. Endovascular treatment is a viable option in patients with both acute and chronic aortic trauma. However, appropriate patient selection criteria, treatment timing, and long-term durability of endovascular repair remain to be defined. We sought to identify appropriate selection criteria and optimal timing of treatment as well as to assess the long-term durability of endovascular repair. SUBJECTS AND METHODS. From July 1997 to December 2001, 19 patients with traumatic aortic injury (11 patients with acute and eight with chronic injuries) were selected for endovascular treatment. In all patients, the lesions were sited at the proximal segment of the descending aorta at a distance of 10 ± 17 mm (mean ± SD) from the left subclavian artery. Nine of the patients with acute injuries were treated after clinical stabilization of other severe associated lesions, whereas two patients, in whom hemodynamic and imaging findings suggested an impending rupture, received emergency treatment. Single-detector helical CT or MR imaging was used for patient selection and stent-graft customization before treatment and for evaluation of patients during the follow-up period. RESULTS. Endovascular stent positioning was successful in all patients. None of the patients developed complications. Aneurysm exclusion and shrinkage were confirmed at follow-up examinations. A partial covering of the subclavian artery occurred in six patients without interrupting the blood flow. All patients remain asymptomatic after a mean follow-up period of 20 months (range, 1-56 months). CONCLUSION. Endovascular repair represents an alternative, minimally invasive treatment, particularly suitable for use in patients with traumatic aortic injuries. The decision of whether to provide immediate emergency treatment or to delay treatment should be based on the lesion characteristics on imaging and clinical findings. The durability of treatment seems to be related to the absence of alteration to the aortic wall at the extremities.

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