FAIRFAX, Va.—Endovascular repair—fixing an injury in a blood vessel from inside that vessel—is abetter option for individuals who receive highly lethal injuries from high-speed collisions or falls (togetherreferred to as blunt trauma) and is shown to save more lives and nearly eliminate paraplegia (the loss of theability to move and/or feel both legs), a complication of surgical repair for thoracic aortic aneurysms.“Analysis of the available data provides unequivocal support for endovascular repair to replace opensurgery as the procedure of choice for repair of the most common traumatic aortic injury,” said Eric K.Hoffer, the director of vascular and interventional radiology at Dartmouth Medical School. “This minimallyinvasive interventional radiology technique can decrease the death rate by half and diminish the risk ofparaplegia by 75 percent as compared to open surgical repair,” he added.Injuries causing thoracic (chest) aortic trauma are life-threatening, often resulting in significantdisability or death. Injuries to the body’s largest artery account for as much as 25 percent of all motorvehicle trauma-related deaths, and most of these individuals die at the scene of the injury, said Hoffer. The10–20 percent who survive and make it to the hospital may die within hours of hospitalization. Theseinjuries may cause partial tears of the artery wall and may not be obvious initially. If left untreated, theartery could expand and eventually rupture, resulting in massive bleeding into the chest that is invariablyfatal, said Hoffer.
During surgery, a patient is at increased risk of paraplegia because the thoracic aorta is clamped,cutting off blood to the spinal column. The interventional radiology treatment does not interrupt the bloodsupply. By entering a branch of the aorta through a small incision in the groin and using long, thin tubescalled catheters, interventional radiologists guide and deliver a stent graft (a tube composed of fabricsupported by a metal mesh) through the blood vessels. When expanded within the artery, the stent graftbridges the injury, reinforcing an artery’s weak spot (the tear), and when successful, eliminates the risk ofcontinued expansion and rupture, said Hoffer. This advance in treatment provides a less invasive optionwith less pain, less recovery time and a lower risk of complications than open surgery.
Researchers systematically reviewed 50 reports with 722 endovascular repairs for this study, publishedin the Journal of Vascular and Interventional Radiology (JVIR), the official journal of the Society ofInterventional Radiology. According to the study, the “endovascular advantage” was demonstrated inrelation to contemporary intensive care and surgical methods, which over the past 30 years decreasedoperative mortality rates from 45–80 percent to 18–28 percent. Endograft repair further reduced mortalityto 8–9 percent. The improved survival rate “may be a result of the decreased systemic stress thatendovascular repair affords,” said Hoffer,” which is important with this group of patients where additionalsevere injuries are common.”
Interventional radiologists, working in multidisciplinary teams with cardiothoracic surgeons andvascular surgeons, pioneered the application of the stent-covered graft for blunt trauma injuries, saidHoffer. Interventional radiologists introduced the idea of taking off-the-shelf stents and vascular graftmaterial to combine them into handmade stent grafts, using these devices to repair lesions from within ablood vessel. This year, SIR celebrates 35 years of quality patient care innovation. “This study providesanother indication of the tremendous innovation in the development of new devices and techniques thatinterventional radiology continues to offer,” said Hoffer.
“Endovascular Stent Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: SystematicReview” is published in the August Journal of Vascular and Interventional Radiology. Co-authors includeAndrew R. Forauer, Anne M. Silas and John M. Gemery, all at Dartmouth Medical School and the Sectionof Vascular and Interventional Radiology.
