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BACKGROUND: Traumatic aortic disruption management has shifted from open repair to endovascular stent grafts. Thoracic stent grafts designed to treat anuersmyl disease, however, may have disadvantages including size mismatch in younger trauma patients and current lengths which nescessatate coverage of 10cm of thoracic aorta which may increase the risk of spinal cord ischemia. The use of abdominal aortic cuffs to treat traumatic aortic disruptions, however, may provide an advantage regarding better size match in the younger trauma patient, reduced thoracic aortic coverage and less cost to the institution.
METHODS: From 2008-2011, sixteen traumatic aortic disruptions were evaluated and managed. The last six were managed with abdominal aortic cuffs (Excluder, Gore, Newark, DE) rather than traditional thoracic stent grafts. In addition to demographics and trauma-relatated data, additional endpoints evaluated in this retrospective review included operative time, number of cuffs utilized, stent cost data, procedural complications and follow up.
RESULTS: In the six patients (5 males/1 female) with traumatic aortic disruption treated with abdominal aortic cuffs, the average age was 27 (range 18-44). The number of cuffs utilized to cover the traumatic tear averaged 2.6 per patient (range 2-3 cuffs per patient) covering an average of 5.3cm of thoracic aorta (range 4-6cm). Procedure times averaged 70 minutes and were without complications including death or spinal cord ischemia. Hospital cost for each cuff was $2200 (average total stent cost per patient $5720). For comparison, a single 10cm TAG graft (Gore) costs $12,500. Average follow up of two years demonstrates no complications or migration of the stent grafts. The following case illustrates a typical patient.
CONCLUSION: Traumatic aortic disruptions can be safely managed with aortic cuffs traditionally used during AAA stent grafting. These may provide advantages over traditional thoracic stents including better size match in a younger trauma patient, less aortic coverage and reduced cost.