Emergency Aortic Stenting Saves Lives

A new, minimally invasive method for repairing aortic injury could help reduce the number of deaths caused by auto accidents and major falls.

Blunt thoracic aortic trauma, usually a non-penetrating "deceleration” injury, such as in an automobile accident, can jerk the aorta forward and back again, causing it to crack. If all three layers of the aorta rupture immediately, the patient will die almost instantly from blood loss. If the outer layer remains intact, however, a weakened area called a pseudoaneurysm can form, which often bursts later. Surgeons must repair the damaged aorta quickly before it ruptures, killing the patient.

A potentially life-saving technique was developed by a team of surgeons from the University of Cincinnati (UC, OH, USA), led by Dr. Joseph Giglia, interim director of UC's division of vascular surgery. They found that by placing a standard surgical stent--a tube-shaped metallic support structure--in the aorta, and lining it with a series of small synthetic grafts called endografts, they could effectively protect the damaged area without stopping blood flow to the rest of the body. Once in place, the dual lining supports the weakened vessel walls and allows blood to continue flowing through the aorta without applying pressure to damaged area. The new technique was reported in the March 2006 edition of Annals of Vascular Surgery.

"Our method gives emergency surgeons a reliable way to repair difficult injuries with readily accessible materials,” said Dr. Giglia. "More people can be treated, and potentially saved, with these minimally invasive techniques.”

While endografts are regularly used in vascular surgery to treat aneurysms in the abdomen, they are too short to fully bridge the damaged area in the chest. And while standard "open” treatment for this type of injury can work, according to Dr. Giglia, it puts significant stress on the patient's heart and brain and increases the risk for heart attack, bleeding, paraplegia and other problems.



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