Early outcome of endovascular treatment of acute traumatic aortic injuries: the talent thoracic retrospective registry.

BACKGROUND: Acute traumatic injury of the thoracic aorta (TAI) is a life-threatening complication in patients who sustain deceleration or crush injuries. This study was conducted to examine the results in patients who underwent endovascular repair with the Talent (Medtronic/AVE, Santa Rosa, CA) thoracic stent graft for acute traumatic injury. METHODS: Out of 457 consecutive endograft patients, 41 (9%) were treated for traumatic aortic conditions. There were 36 males with a mean age of 36 +/- 14 years. Mean aortic diameter at the time of intervention was 34 mm +/- 9 (range, 20 to 70 mm). The mean length of covered aorta was 106 mm (range, 5 to 130 mm) with only one stent graft used in 98% (40) of all cases. Median follow-up period for hospital survivors was 13 months (1.0 to 69.0 months). RESULTS: Stent graft implantation was technically successful in all cases (100%). One patient died during hospitalization, yielding an overall in-hospital mortality rate of 2.4%. Procedural-related paraplegia was zero and a primary endoleak was observed in 1 patient. Postoperative complications occurred in 4 patients (3 respiratory failures, 1 multiorgan failure). No patient required conversion to open surgical repair. CONCLUSIONS: The treatment of acute traumatic injuries of the descending thoracic aorta with the Talent stent graft is a feasible and safe technique; it provides low morbidity and mortality rates in the early postoperative period, and early results are encouraging. However, long-term studies are worthwhile to evaluate the effectiveness and the durability of this procedure.

Endovascular treatment of acute and chronic aortic dissection: midterm results from the Talent Thoracic Retrospective Registry.

OBJECTIVE: This study examined midterm results after treatment with the endovascular Talent thoracic stent graft (Medtronic/AVE, Santa Rosa, Calif) in patients with acute or chronic aortic dissection. METHODS: In the Talent Thoracic Retrospective Registry, 180 patients were treated for acute or chronic aortic dissection (mean age: 59.6 +/- 13.0 years). Thirty-seven (20.6%) patients had acute aortic complications with signs of rupture, distal malperfusion, or persistent pain; the remainder were in stable condition. Aortic diameter was 53.5 +/- 14.3 mm, the distance from the left subclavian artery to the proximal entry tear was 44.1 +/- 41.9 mm, and dissection extended beyond the celiac axis in 88.3% of cases. Length of covered aorta measured 138.9 +/- 45.7 mm, with one stent graft used in 125 (69.4%) patients. RESULTS: Procedural success was 98.3%. Nine patients died within 30 days, yielding an overall early mortality of 5.0%. For in-hospital outcome, multivariate analysis showed that age greater than 75 years (odds ratio [OR] 4,9; 95% confidence intervals [CI] 1.6-15.1; P = .006), American Society of Anesthesiologists class greater than III (OR 2.8; 95% CI 1.0-7.5; P = .04), and emergency status (OR 3.5; 95% CI 1.3-8.9; P = .01) were independent predictors of major adverse events. Compared with electively treated patients, emergency status was associated with a higher incidence of in-hospital mortality (13.5% vs 2.1%; P = .003) and neurologic events (16.2% vs 4.2%; P = .01). However, patients with acute dissection had a smaller baseline diameter and were less often identified to have secondary endoleaks and progressive enlargement. Average follow-up for hospital survivors was 22.3 +/- 17.0 months with an estimated survival of 94.9% +/- 1.7% at 30 days, 90.6% +/- 2.3% at 12 months, 90.6% +/- 2.3% at 24 months, and 81.8% +/- 4.8 % at 36 months. During follow-up, 30 patients required a total of 32 secondary interventions including 12 open and 20 endovascular procedures, accounting for an estimated 71.5% freedom from reinterventions at 36 months. Follow-up imaging revealed stable or decreasing thoracic aortic diameter in 80.5% of patients. CONCLUSION: Endovascular treatment for aortic dissection is associated with reasonably low morbidity and mortality. Long-term surveillance is crucial to define more comprehensively the durability of stent graft treatment of aortic dissection and to determine which patients are appropriate candidates for stent graft therapy.