Endovascular repair for acute rupture of the descending thoracic aorta

Purpose: To report the endovascular treatment of acute descending thoracic aortic rupture as an alternative to open surgery in high-risk patients. Methods: Between November 1999 and April 2001, 10 patients (7 men; median age 75 years) underwent endovascular stent-grafting of the descending thoracic aorta for acute rupture from an aneurysm (n=7) or blunt trauma (n=3). All patients were evaluated as high operative risk. The aortic rupture was associated with isolated mediastinal hematomas (n=7), left hemothorax (n=2), or aortobronchial fistula (n=1). The Excluder Thoracic Endoprosthesis was used predominantly. Results: The mean interval to the endovascular repair was 45.3 +/- 28.4 hours. All stent-grafts were successfully deployed. Two patients required common iliac artery access, and 2 needed covered stents for iatrogenic iliac artery rupture. There was 1 postoperative death (myocardial infarction) and no renal failure, neurological complications, embolization, stent-graft migration, or perigraft leak. One patient died 4 months later from an unrelated cause. At a mean follow-up of 7.9 +/- 5.1 months, all aneurysms and rupture sites were excluded with no evidence of endoleak or hematoma. Conclusions: Endoluminal treatment is a feasible technique for the management of acute rupture of the descending thoracic aorta. Long-term studies are required to assess the effectiveness and durability of this technique in comparison to open repair.