EFFECTIVENESS EVALUATION OF THORACIC ENDOVASCULAR AORTIC REPAIR FOR BLUNT THORACIC AORTIC INJURY WITH HOSTILE STENT-GRAFT PROXIMAL LANDING ZONE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENFeng ,  GUOWei , SONGYuxiang , SUNGuoyi , XIONGJiang , JIAXin , LIUXiaoping , MAXiaohui , ZHANGHongpeng

Department of Vascular and Endovascular Surgery, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;

Corresponding author：

GUOWei, Email: pla301dml@vip.sina.com

Keywords：

Blunt thoracic aortic injury; Aortic isthmus; Thoracic endovascular aortic repair; Stent-graft

DOI：

10.7507/1002-1892.20160121

Video：

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Objective To explore the effectiveness of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) with hostile stent-graft proximal landing zone. Methods A retrospective analysis was made on the clinical data of 13 patients with BTAI with hostile stent-graft proximal landing zone treated by TEVAR between December 2007 and December 2014. There were 10 males and 3 females with the mean age of 44 years (range, 24-64 years). The imaging examination indicated Stanford type B aortic dissection in 7 cases, pseudoaneurysm in 3 cases, aneurysm in 1 case, and penetrating ulcer in 2 cases. According to the partition method of thoracic aortic lesion by Mitchell, 8 cases underwent stent-graft with left subclavian artery (LSA) coverage, 3 underwent chimney stents for LSA, and 2 for left common carotid artery (LCCA). In 2 cases receiving chimney TEVAR involving LCCA, one underwent steel coils at the proximal segment of LSA to avoid type II endoleak and the other underwent in situ fenestration for endovascular reconstruction of LSA. Results All TEVAR procedures were successfully performed. The mean operation time was 1.8 hours (range, 1-3 hours); the mean intraoperative blood loss was 120 mL (range, 30-200 mL); and the mean hospitalization time was 15 days (range, 7-37 days). No perioperative death and paraplegia occurred. The patients were followed up 3-30 months (mean, 18 months). Type I endoleak occurred in 1 case during operation and spontaneously healed within 6 months. Hematoma at brachial puncture site with median nerve compression symptoms occurred in 1 case at 3 weeks after operation; ultrasound examination showed brachial artery pseudoaneurysm and thrombosis, and satisfactory recovery was obtained after pseudoaneurysmectomy. No obvious chest pain, shortness of breath, left upper limbs weakness, numbness, and dizziness symptoms were observed. Imaging examination revealed that stentgraft and branched stent remained in stable condition. Meanwhile the blood flow was unobstructed. No lesions expanded and ruptured. No new death, bacterial infection, or other serious complications occurred. Conclusion According to Mitchell method, individualized plan may be the key to a promising result. More patients and further follow-up need to be included, studied, and observed.

Citation： CHENFeng, GUOWei, SONGYuxiang, SUNGuoyi, XIONGJiang, JIAXin, LIUXiaoping, MAXiaohui, ZHANGHongpeng. EFFECTIVENESS EVALUATION OF THORACIC ENDOVASCULAR AORTIC REPAIR FOR BLUNT THORACIC AORTIC INJURY WITH HOSTILE STENT-GRAFT PROXIMAL LANDING ZONE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(5): 599-603. doi: 10.7507/1002-1892.20160121 Copy

1.	Urgnani F, Lerut P, Da Rocha M, et al. Endovascular treatment of acute traumatic thoracic aortic injuries:a retrospective analysis of 20 cases. J Thorac Cardiovasc Surg, 2009, 138(5):1129-1138.
2.	Challoumas D, Dimitrakakis G. Blunt thoracic aortic injuries:new perspectives in management. Open Cardiovasc Med J, 2015, 9:69-72.
3.	Coady MA, Ikonomidis JS, Cheung AT, et al. Surgical management of descending thoracic aortic disease:open and endovascular approaches:a scientific statement from the American Heart Association. Circulation, 2010, 121(25):2780-2804.
4.	Prêtre R, Chilcott M. Blunt trauma to the heart and great vessels. N Engl J Med, 1997, 336(9):626-632.
5.	Mitchell RS, Ishimaru S, Ehrlich MP, et al. First International Summit on Thoracic Aortic Endografting:roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther, 2002, 9 Suppl 2:II98-105.
6.	刘昌伟, 郑月宏. 血管损伤的腔内治疗. 中国实用外科杂志, 2007, 27(7):521-523.
7.	Khoynezhad A, Donayre CE, Azizzadeh A, et al. One-year results of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial). J Thorac Cardiovasc Surg, 2015, 149(1):155-161. e4.
8.	赵海格, 李鸣, 汪忠镐, 等. 带膜支架治疗胸主动脉减速伤所致假性动脉瘤. 浙江医学, 2004, 26(9):678-679.
9.	Agostinelli A, Saccani S, Borrello B, et al. Immediate endovascular treatment of blunt aortic injury:our therapeutic strategy. J Thorac Cardiovasc Surg, 2006, 131(5):1053-1057.
10.	Murphy EH, Dimaio JM, Dean W, et al. Endovascular repair of acute traumatic thoracic aortic transection with laser-assisted insitu fenestration of a stent-graft covering the left subclavian artery. J Endovasc Ther, 2009, 16(4):457-463.
11.	Lin CC, Liu KS, Chen HW, et al. Blunt aortic injury:risk factors and impact of surgical approaches. Surg Today, 2016, 46(2):188-196.
12.	El-Sayed H, Ramlawi B. The current status of endovascular repair of thoracic aortic aneurysms (TEVAR). Methodist Debakey Cardiovasc J, 2011, 7(3):15-19.
13.	Serra R, de Franciscis S, Grande R, et al. Endovascular repair for acute traumatic transection of the descending thoracic aorta:experience of a single centre with a 12-years follow up. J Cardiothorac Surg, 2015, 10:171.
14.	Canaud L, Marty-Ané C, Ziza V, et al. Minimum 10-year followup of endovascular repair for acute traumatic transection of the thoracic aorta. J Thorac Cardiovasc Surg, 2015, 149(3):825-829.
15.	Brinster DR. Endovascular repair of blunt thoracic aortic injuries. Semin Thorac Cardiovasc Surg, 2009, 21(4):393-398.
16.	Pratesi C, Dorigo W, Troisi N, et al. Acute traumatic rupture of the descending thoracic aorta:endovascular treatment. Am J Surg, 2006, 192(3):291-295.
17.	Antonello M, Menegolo M, Maturi C, et al. Intentional coverage of the left subclavian artery during endovascular repair of traumatic descending thoracic aortic transection. J Vasc Surg, 2013, 57(3):684-690. e1.
18.	Carmona AF, Redondo AD, Pareja JC, et al. Endovascular treatment of descending thoracic aortic rupture:mid-to long-term results in a single-centre registry. J Cardiovasc Med (Hagerstown), 2012, 13(4):266-268.
19.	Oberhuber A, Schabhasian D, Kohlschmitt R, et al. The bird beak configuration has no adverse effect in a magnetic resonance functional analysis of thoracic stent grafts after traumatic aortic transection. J Vasc Surg, 2015, 61(2):365-373.

1. Urgnani F, Lerut P, Da Rocha M, et al. Endovascular treatment of acute traumatic thoracic aortic injuries:a retrospective analysis of 20 cases. J Thorac Cardiovasc Surg, 2009, 138(5):1129-1138.
2. Challoumas D, Dimitrakakis G. Blunt thoracic aortic injuries:new perspectives in management. Open Cardiovasc Med J, 2015, 9:69-72.
3. Coady MA, Ikonomidis JS, Cheung AT, et al. Surgical management of descending thoracic aortic disease:open and endovascular approaches:a scientific statement from the American Heart Association. Circulation, 2010, 121(25):2780-2804.
4. Prêtre R, Chilcott M. Blunt trauma to the heart and great vessels. N Engl J Med, 1997, 336(9):626-632.
5. Mitchell RS, Ishimaru S, Ehrlich MP, et al. First International Summit on Thoracic Aortic Endografting:roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther, 2002, 9 Suppl 2:II98-105.
6. 刘昌伟, 郑月宏. 血管损伤的腔内治疗. 中国实用外科杂志, 2007, 27(7):521-523.
7. Khoynezhad A, Donayre CE, Azizzadeh A, et al. One-year results of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial). J Thorac Cardiovasc Surg, 2015, 149(1):155-161. e4.
8. 赵海格, 李鸣, 汪忠镐, 等. 带膜支架治疗胸主动脉减速伤所致假性动脉瘤. 浙江医学, 2004, 26(9):678-679.
9. Agostinelli A, Saccani S, Borrello B, et al. Immediate endovascular treatment of blunt aortic injury:our therapeutic strategy. J Thorac Cardiovasc Surg, 2006, 131(5):1053-1057.
10. Murphy EH, Dimaio JM, Dean W, et al. Endovascular repair of acute traumatic thoracic aortic transection with laser-assisted insitu fenestration of a stent-graft covering the left subclavian artery. J Endovasc Ther, 2009, 16(4):457-463.
11. Lin CC, Liu KS, Chen HW, et al. Blunt aortic injury:risk factors and impact of surgical approaches. Surg Today, 2016, 46(2):188-196.
12. El-Sayed H, Ramlawi B. The current status of endovascular repair of thoracic aortic aneurysms (TEVAR). Methodist Debakey Cardiovasc J, 2011, 7(3):15-19.
13. Serra R, de Franciscis S, Grande R, et al. Endovascular repair for acute traumatic transection of the descending thoracic aorta:experience of a single centre with a 12-years follow up. J Cardiothorac Surg, 2015, 10:171.
14. Canaud L, Marty-Ané C, Ziza V, et al. Minimum 10-year followup of endovascular repair for acute traumatic transection of the thoracic aorta. J Thorac Cardiovasc Surg, 2015, 149(3):825-829.
15. Brinster DR. Endovascular repair of blunt thoracic aortic injuries. Semin Thorac Cardiovasc Surg, 2009, 21(4):393-398.
16. Pratesi C, Dorigo W, Troisi N, et al. Acute traumatic rupture of the descending thoracic aorta:endovascular treatment. Am J Surg, 2006, 192(3):291-295.
17. Antonello M, Menegolo M, Maturi C, et al. Intentional coverage of the left subclavian artery during endovascular repair of traumatic descending thoracic aortic transection. J Vasc Surg, 2013, 57(3):684-690. e1.
18. Carmona AF, Redondo AD, Pareja JC, et al. Endovascular treatment of descending thoracic aortic rupture:mid-to long-term results in a single-centre registry. J Cardiovasc Med (Hagerstown), 2012, 13(4):266-268.
19. Oberhuber A, Schabhasian D, Kohlschmitt R, et al. The bird beak configuration has no adverse effect in a magnetic resonance functional analysis of thoracic stent grafts after traumatic aortic transection. J Vasc Surg, 2015, 61(2):365-373.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS EVALUATION OF THORACIC ENDOVASCULAR AORTIC REPAIR FOR BLUNT THORACIC AORTIC INJURY WITH HOSTILE STENT-GRAFT PROXIMAL LANDING ZONE

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