Endovascular treatment of traumatic rupture of the thoracic aorta

Background: Traumatic rupture of the thoracic aorta is a life-threatening event. Open surgical repair is the 'gold standard', but is associated with high mortality and morbidity rates. Endovascular repair is emerging as a potentially safer alternative. Methods: A systematic review was performed of all published literature on this subject, including the authors' own experience. Using Sumsearch, PubMed and cross-references, all published reports up to January 2006 were identified, and analysed for injuries, perioperative morbidity, mortality, operating time, hospital stay and follow-up. Results: A total of 284 patients were identified. Reported mortality rates range from 0 to 6 per cent. The procedure-related mortality rate is about 1.5 per cent. Some 6.7 per cent of all procedures were complicated by endoleak and the overall procedure-related morbidity rate was 14.4 per cent. These results are promising compared with those of open repair, but individual experience is limited and there may be some publication bias. Conclusion: Endovascular repair of traumatic rupture of the thoracic aorta seems to reduce morbidity and mortality in patients with multiple trauma. Ideally, both devices and experienced personnel should be available in trauma centres.