The Optimal Timing of Endovascular Treatment for Grade 3-4 Blunt Aortic Injury and Traumatic Type B Aortic Dissection

Hirohito Ishii, Kunihide Nakamura, Eisaku Nakamura

Division of Cardio- vascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Japan

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–A

Abstract

Objective; The purpose of this study was to evaluate theoptimal timing for TEVAR of high-gradeblunt aortic injuries and traumatic type B dissection (TBD).

Methods; From 2012 to 2017 in our hospital, 11 trauma patients except almost immediate death diagnosed withSociety for Vascular Surgery　(SVS) grade 3-4 and TBD on enhanced CT (SVS grade 3; 7, SVS grade 4; 2, TBD; 2). All those patients were indicated for TEVAR and also priority for treatment ofthe patients with multiple injuries was control of hemorrhage into free space.

Results; Patient’s mean age was 59.3 ± 12.5, 7 patients of 11 were hemodynamically unstable. For SVS grade 3-4, the interval times between the arrival at hospital and admittance to the surgical room were 179.4 min (45-357 min), and 2 patients with intra-abdominal bleeding restrained hemorrhage before TEVAR. Patients of TBD performed TEVAR 2-3 months after with cautious follow-up. Endograft technical success was obtained in all case without aortic related events and endovascular specific complication. One patient died because of SARS and ARDS at POD 3. Also 8 patients coexisted with respiratory compromise, and before TEVAR 7 patient were on a mechanical ventilator, the tracheal intubation times were 13.0 ± 6.8 days.

Conclusion; Because patients of SVS grade 3 were become compromised respiratory function at high-rate, those have to put a quick end to perform TEVAR if possible. On the other hand patients of TBD may be able to performed elective TEVAR.