Endovascular treatment for acute traumatic transection of the descending aorta: Focus on operative timing and left subclavian artery management

Objective: The operative timing and management of acute traumatic aortic rupture are matters of debate. We reviewed our experience with endovascular repair of acute traumatic aortic rupture, focusing on these topics. Methods: From 1998 to 2007, 31 patients were referred to our institute for acute traumatic rupture of the descending aorta. In 11 patients (group I) an early stent graft procedure was performed, whereas in 16 patients (group II) endovascular repair was delayed. The median time from trauma was 24 hours in group I and 1.5 months in group II. Eight (25.8%) patients had a short proximal neck (< 5 mm from the left subclavian artery). Of these, 2 had the left subclavian artery totally covered by the endoprosthesis, and 2 had the left subclavian artery partially covered. Four patients with a posttraumatic pseudoaneurysm involving the left subclavian artery (3 patients) or the left common carotid artery (1 patient) underwent conventional open surgical intervention. Results: Technical success was obtained in all patients. There were neither intraoperative nor perioperative deaths. Cerebellar stroke was detected in 1 patient after the intentional closure of the left subclavian artery. Followup (32.7 +/- 27.5 months) was 100% complete. No late deaths, endoleaks, or complications occurred. Conclusion: The endovascular approach was a safe and flexible procedure in traumatic aortic rupture and allowed us to fit the operative timing to every patient's clinical and imaging findings. In the presence of an inadequate proximal landing zone, conventional open surgical intervention still remains a favorable option as an alternative to endovascular procedures if a surgical revascularization of the left subclavian artery, carotid artery, or both is necessary.