TEVAR should be considered first line therapy for acute traumatic aortic rupture

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When compared with open repair, endovascular repair of traumatic thoracic aortic rupture is associated with a lower rate of death and therefore should be considered as the first line therapy for acute traumatic rupture of the thoracic aorta, Ludovic Canaud, A de Villeneuve Hospital, Montpellier, France, told delegates at the Society for Vascular Surgery Annual Meeting in Chicago, USA.

Canaud presented the results of a study which sought to compare the outcome between open and endovascular repair of acute traumatic rupture of the thoracic aorta.

 

Seventy five patients (mean age 38.6±10.7 years) with an acute traumatic aortic rupture were referred to our hospital between January 1990 and November 2010. Thirty six patients (34 men, mean age 34.2±10.8 years) underwent surgical repair using cardiopulmonary bypass. Endovascular repair was performed in 45 patients (33 men, mean age 40.3+/-11 years. The two groups were statistically comparable.

 

The overall mortality was significantly lower for the endovascular group (p=0.03) and was respectively 11.1% (intra-operative mortality 8.3%) for the surgical group and 2.2% (intra-operative mortality 0%) for the endovascular group. The mortality rate related to aortic repair for the surgical and endovascular groups was respectively 11.1% and 0%. In the surgical group, the morbidity rate was 13.8%: four cases of recurrent nerve palsy and one false anastomotic aneurysm were diagnosed at 52 months. In the endovascular group, the morbidity rate was 15.5%: three cases of intra-operative inadvertent coverage of supra-aortic trunks (requiring in two cases a secondary procedure after one and two years to revascularise the supra-aortic trunks), one proximal type I endoleak (requiring deployment of a second stent-graft at day 2), two stent graft collapses in the first postoperative month (treated by open repair and explantation in one case and by the deployment of a second stent-graft in the other case) and one intra-operative iliac rupture (surgically repaired) were seen. No cases of paraplegia or stroke were observed. The median follow-up was 8.7 years (range 0.2–15).

 

In conclusion, Canaud said that endovascular repair should be considered as the first line therapy for acute traumatic rupture of the thoracic aorta, except in some rare but challenging anatomic situations.

 

“Open repair remains a valid option in cases of high aortic arch angulation, small diameter aorta and closeness to the supra-aortic trunks,” he said.

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