ENDOVASCULAR REPAIR OF TRAUMATIC AORTIC RUPTURE: A SINGLE CENTER EXPERIENCE

Background. Open surgery of the type B Aortic Dissection (tB-AD) is still challenging with high morbidity and mortality, thoracic endovascular aortic repair (TEVAR) has shown improved early and late results, compared with open surgery or medical therapy, mostly in complicated patients. To assess the outcome after TEVAR for tB-AD, we retrospectively reviewed our long term experience. Methods. From March 2001 to December 2012, out of 165 patients undergone TEVAR, 75 patients were treated for tB-AD, 49 for complicated acute dissection occurring within 14 days after onset of symptoms and 26 for chronic dissection after 14 days from first symptoms. A spiral computed tomographic (CT) scan, were performed preoperatively to assess suitability for TEVAR, for measuring and localizing purposes and determining the size of the implanting stent grafts. The procedure was performed in a hybrid operating room. Patients received general anesthesia and mechanical ventilation. Patients were followed in a clinical registry. Clinical outcomes, including primary end point (early and late mortality) and secondary end points (early and late major complications) were evaluated. Results. The procedure was successfully completed in all patients with no periprocedural death or surgical conversion. The overall 30-days mortality was 2.7% (2 patients). Intentional partial or full left subclavian artery overstenting, without previous revascularization, was achieved in 24 patients (32.0%). A secondary endovascular or conventional procedure was required in 5 patients (6.7%). Conclusions. The early and mid-term technical and clinical results support the safety and effectiveness of TEVAR that is revealed immediate therapeutic resolution also in the treatment of the acute and chronic type B aortic dissection. However, long-term follow-up and additional studies are mandatory to detect late failure and to confirm clinical safety of this procedure.