Ravi R. Rajani, Laura S. Johnson, Brian L. Brewer, Luke P. Brewster, Matthew A. Corriere, Yazan Duwayri, James G. Reeves, Joseph J. Ricotta, Ravi K. Veeraswamy, Thomas F. Dodson
Department of Vascular Surgery, Emory University, Atlanta, GA.
OBJECTIVES: Traumatic transection of the thoracic aorta is being treated increasingly with the use of aortic stent grafting. Unfortunately, most stent grafts are designed for treating aortic aneurysmal disease instead of traumatic injury. Further refinements in stent graft technology depend on a thorough anatomic understanding of the transection process.
METHODS: All patients with computed tomography evidence of blunt aortic injury between 2003 and 2011 were queried. Their initial scans were imported into the Intuition (Terarecon, Inc.) viewing program, and off-line centerline reconstruction was performed. Standard demographic data was collected in addition to anatomic characteristics, including aortic diameters and relation of the injury to the arch vessels.
RESULTS: Fifty-two patients were identified. Only 2 patients had evidence of injury proximal to the left subclavian artery. The average length from the left subclavian artery to the proximal site of injury was 16.2 mm (range 2-31 mm). Most patients (40) had more than 15 mm of landing zone beyond the left subclavian artery. The range of proximal diameters ranged from 19-32 mm, with an average aortic diameter of 23.7 mm. Five patients had aortic diameters smaller than 21 mm, and five patients had aortic diameters greater than 26 mm. The average length of injured aortic segment was 27 mm.
CONCLUSIONS: In this contemporary series from a large trauma center, 98% of patients are anatomically able to be treated with a stent graft that does not require coverage of the left common carotid artery. Furthermore, 80% of patients were anatomically able to be treated without left subclavian artery coverage. Most patients have an aortic diameter that falls between 21 and 26 mm in diameter as well as a short segment of injured artery. Centers interested in emergently treating aortic transections are able to do so while maintaining a limited stock of stent grafts that can be used to treat the majority of the population.
AUTHOR DISCLOSURES: B. L. Brewer, Nothing to disclose; L. P. Brewster, Nothing to disclose; M. A. Corriere, Nothing to disclose; T. F. Dodson, Nothing to disclose; Y. Duwayri, Nothing to disclose; L. S. Johnson, Nothing to disclose; R. R. Rajani, Nothing to disclose; J. G. Reeves, Nothing to disclose; J. J. Ricotta, Nothing to disclose; R. K. Veeraswamy, Nothing to disclose.
Posted April 2012