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Home > Press Center > Endovascular Repair of Traumatic Thoracic Aortic Injury Shows Promise

Contact:
Emily Kalata
Assistant Director, Communications
312.334.2309

Surgeons from the University of Maryland and Maryland Shock Trauma Center in Baltimore have released positive results of their first 20 patients with traumatic thoracic aortic injury treated with endograft repair. Details of their study appear in the March 2007 Journal of Vascular Surgery.

Researchers noted that the aorta is the largest human artery and runs through the chest and abdomen to carry blood from the heart to the rest of the body. Most thoracic aortic injuries are caused by force of a vehicle crash that tears the wall of the aorta, and victims can rapidly bleed to death. Fifteen of the 20 patients in this study were in a car crashes, three were on motorcycles and two were injured in falls. In the past, the only way to repair such a tear in the aorta was to open the chest, clamp off the aorta for a period of time and replace the injured aorta with a fabric graft - a procedure that carries a high risk of death and paralysis. While many victims die before reaching the hospital, almost one-third of those who do get to a medical facility will not survive these procedures.

David G. Neschis, MD, assistant professor of surgery at the University of Maryland School of Medicine, explained that the less invasive, endograft procedure requires no surgery in the chest; instead it is performed through a tiny incision in the groin. Using X-ray guidance, the endograft, a tube-shaped device, is passed up through the blood vessels, and opened inside the injured portion of the aorta. The endograft bridges the injured area to allow circulation through the aorta without continued hemorrhage.

All endograft repairs were completed with no immediate complications. No patients were lost as a result of their aortic injury; however four patients died from other severe injuries including head, chest and abdominal trauma. None of the survivors were paralyzed, a complication that can occur in 14 percent of patients repaired with open thoracic aortic surgery. The average age of patients was 40 years, and 85 percent were male.

“There are few things more devastating than the loss of a young life in a motor vehicle crash, or a surviving victim waking up paralyzed,” said Dr. Neschis. “We believe that our less invasive procedure has significantly reduced the risk of paralysis associated with aortic injury repair.”

He added that endograft repair is particularly beneficial in patients who have other serious injuries and may be in no condition to tolerate open chest surgery. “If it wasn’t for the other injuries these patients have had,” said Dr. Neschis, “they possibly would have been able to go home the next day.”

“So far, the non-invasive alternative treatment for younger accident victims appears to be safe and effective,” said Dr. Neschis. “Endograft repair is probably the single most significant advance in the treatment of aortic trauma in the last 50 years. We hope our report will help vascular surgeons develop their endovascular skills, offer this new treatment to patients and create programs at their institutions, as we continue to improve the care of trauma victims.”