Traumatic aortic tear
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Transcript of Traumatic aortic tear
Adeli B, Gale J, Boyne N, McGahan T, Jackson M, Golledge J, Wu R, Buckenham T, Walker PJ.
TEVAR for traumatic aortic tear:
The Queensland experience.
Department of Vascular Surgery, Royal Brisbane & Women’s Hospital, University of Queensland, Department of Surgery and Centre for Clinical
Research, Brisbane, Australia.
� TEVAR has become an established treatment for traumatic aortic tears
(TAT) in many centres worldwide.
� No individual centre has a large experience with this condition.
The aim of this project was
to establish a Queensland
registry to document the registry to document the
clinical presentation,
procedural outcomes, and
follow-up results of TEVAR
for traumatic aortic injury.
� Funding was obtained from the CONROD-RACS Trauma
Fellowship to establish a state-wide registry with the
agreement and participation of the Vascular Surgery Units
throughout Queensland.
� Agreement was obtained from the New Zealand Registry to � Agreement was obtained from the New Zealand Registry to
allow us to mirror their data set.
� Inclusion criteria
� blunt trauma
� Exclusions
� deaths before intervention
� penetrating trauma (eg GSW, fish bone)
� Data was collected on a
retrospective basis on patients
already treated, and for new cases
the data is being collected on a
prospective basis.prospective basis.
� Data sheets and a SPSS database
were developed
� Patient demographics & risk factors
� Trauma aetiology
� Procedural details including adjunctive
procedures
� Outcomes
� Between 1996 and 2010 38 patients underwent
TEVAR for blunt TAT
mean age 43 years (range 17-78)� mean age 43 years (range 17-78)
� 80% (n=30) male
� 36 acute < 2 weeks
� 2 chronic 33 , 155 days
� MVA 19
� MBA 10
� Falls 4
Crush injury 3� Crush injury 3
� 2x work related
� 1x farm machinery
� Push bike 1
� Hang glider towed by car 1
� Descending TA 31� Descending TA 31
� Isthmus 4
� Arch 3
� All had significant associated injuries, predominantly
musculoskeletal and lung injury.
� 40% haemodynamically unstable at some stage
preoperatively; five patients had a systolic BP < preoperatively; five patients had a systolic BP <
100mmHg recorded pre-op in hospital.
� GCS was normal in 63%.
� ASA grade:
� ASA1 18%
� ASA2 9%
� ASA3 27%
� ASA4 46%
� Mean time between admission and surgery was 180 hr, 12 min (range 34
mins - 155 days); Median 11 hours, 19 mins
� For the acute (<2 week) patients 55 hours, 5 minutes
Patient ID
� 42% (n=15) had their TEVAR on the day of admission
� 34% (n=13) had their TEVAR on day two.
� One half had surgery outside normal hours.
� All procedures were performed under GA in a:
� Surgical Theatre 22
� Endovascular Suite 10
� Radiology Suite 6
� Femoral in 36 cases (95%)
� Iliac in two patients
� one direct CIA access
� one iliac conduit
Cook Zenith TX2
Cook TBE
22
3
Medtronic Talent 8
WL Gore TAG 3
� mean of 1.1 devices
� one prosthesis in 35 patients, 2 in 2 patients, 3 in 1 patient
� Intra-operative antihypertensive – 3 (9 %)
� Intra-operative heparin – 27 (73%)
� left SCA was
covered in 11
cases (29%)
� no other arch
vessels were
covered
� Two patients required ilio-femoral bypass grafts
for iliac vessel injury.
� No patient required conversion to open repair.
Mean procedure time was 2 hrs and 15 mins
(median 2:01; range 59 mins – 4:45)
Patient ID
� no procedures were abandoned
� no conversions to open repair
� 2 patients required further stent-grafting during their initial
admission for proximal and distal endoleaksadmission for proximal and distal endoleaks
� 1 perioperative death due to multisystem failure (2.6%)
� morbidity occurred in 23 patients (42%).
Graft related
� 2 endoleaks required further stenting – 1 endoleak persists
Neurological
� There was no instance of paraparesis / paraplegia
1 TIA ( blurred vision in right eye for few minutes)� 1 TIA ( blurred vision in right eye for few minutes)
Other
� 4 patients had groin / access site complications
� 1 infection and 3 fluid collection/haematoma
� 4 post implantation fever with no defined sepsis
� 4 prolonged ventilation and 2 others suffered pneumonia
� 1 patient suffered a PE and received an IVC filter
� 2 patients developed ARF (not requiring dialysis)
� Mean hospital stay was 49 days (median 27, range 3 - 328 days)
Patient ID
� FU range 10 days– 11 years
� 37 alive at last FU
� 17 lost to FU (refuse travel / treatment / reviews elsewhere)
� Mean FU for 20 patients still under surveillance = 20.4
monthsmonths
� 1 persisting endoleak – no further treatment so far
� 1 left CCA-SCA bypass for arm claudication and subclavian
steal symptoms @ 2years post TEVAR
� 1 left CCA-SCA bypass for arm claudication @ 5 weeks –
complicated by post-op Horner’s syndrome
� 1 persistent L thigh numbness from groin incision @ 28 weeks
� The early results of TEVAR for TAT in Queensland patients are
comparable to those reported by other centers around the world
� Low in hospital and 30 day mortality (2.6%)
� No paraplegia� No paraplegia
� Low stent graft related complication rate
� No Migration
� Significant hospital LOS
� Concerning loss to FU (45%)
� Long-term surveillance will enable us to determine the late outcome
and durability of this technique particularly in younger individuals.
� In the future, it is hoped to combine with the NZ Registry, and ultimately
to expand to a bi-national online registry including all states and
territories and encompassing all indications for TEVAR as already occurs
in NZ.
Thank youThank you