Indications for, Timing of, and Results of Catheter-Based Treatment of Traumatic Injury to the Aorta

Indications for, Timing of, and Results of Catheter-Based Treatment of Traumatic Injury to the Aorta

Rossella Fattori¹, Gabriella Napoli¹, Luigi Lovato¹, Vincenzo Russo¹, Davide Pacini², Angelo Pierangeli² and Giampaolo Gavelli¹

^¹ Department of Radiology, Cardiovascular Unit, University Hospital S. Orsola, Via Massarenti, 9, 40138 Bologna, Italy.
^² Department of Cardiac Surgery, University Hospital S. Orsola, 40138 Bologna, Italy.

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Fig. 1A. —28-year-old man with acute traumatic aortic rupture. Single-detector helical CT scan obtained at hospital admission 6 hr after trauma shows circumferential, irregular aortic lesion. Note wide periaortic and pleural effusion.

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Fig. 1B. —28-year-old man with acute traumatic aortic rupture. Helical CT scan obtained 1 week after endovascular treatment shows aneurysm exclusion.

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Fig. 1C. —28-year-old man with acute traumatic aortic rupture. Helical CT scan obtained at 1-year follow-up shows complete resolution of aortic lesion.

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Fig. 1D. —28-year-old man with acute traumatic aortic rupture. Oblique sagittal volume-rendered reformatted CT image of thoracic aorta shows resolution of posttraumatic aneurysm. Note patency of left subclavian artery.

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Fig. 2A. —35-year-old man with posttraumatic aneurysm who underwent intraoperative angiography. Digital subtraction angiogram obtained before endovascular treatment reveals posttraumatic aneurysm of isthmic aorta.

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Fig. 2B. —35-year-old man with posttraumatic aneurysm who underwent intraoperative angiography. Digital subtraction angiogram obtained after procedure shows that stent has been deployed in isthmic aorta, with aneurysm exclusion and patency of left subclavian artery. Marker (arrow) indicating point of Dacron (DuPont, Wilmington, DE) coverage is below origin of left subclavian artery, but flow is not interrupted.

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Fig. 2C. —35-year-old man with posttraumatic aneurysm who underwent intraoperative angiography. Multiplanar (C) and volume-rendering (D) reconstructions of CT scans obtained during follow-up period shows complete thrombosis of aneurysm and patency of left subclavian artery. Marker (arrow) indicating point of Dacron coverage is visible.

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Fig. 2D. —35-year-old man with posttraumatic aneurysm who underwent intraoperative angiography. Multiplanar (C) and volume-rendering (D) reconstructions of CT scans obtained during follow-up period shows complete thrombosis of aneurysm and patency of left subclavian artery. Marker (arrow) indicating point of Dacron coverage is visible.

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Fig. 3. —Graph shows evolution of posttraumatic aneurysms in 19 patients after endovascular treatment. In most patients, greatest reduction in size of thrombosed aneurysms occurred within first 6 months. After that time, aneurysmal dimensions remained stable.

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Fig. 4A. —47-year-old man with chronic posttraumatic aneurysm. Axial spin-echo MR image obtained before endovascular treatment shows large posttraumatic aneurysm.

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Fig. 4B. —47-year-old man with chronic posttraumatic aneurysm. Helical CT scan obtained 6 months after endovascular treatment shows thrombosis of aneurysm with no endoleakage.

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Fig. 4C. —47-year-old man with chronic posttraumatic aneurysm. Helical CT scan obtained at 1-year follow-up examination shows obvious total aneurysm shrinkage.

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Fig. 5A. —66-year-old man with chronic posttraumatic aneurysm. Axial spin-echo MR image obtained before treatment.

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Fig. 5B. —66-year-old man with chronic posttraumatic aneurysm. Helical CT scan (B) and multiplanar reconstructed CT image (C) obtained 1 year after stent-graft placement show complete aneurysm exclusion with no significant shrinkage. Note linear calcification of adventitial wall.

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Fig. 5C. —66-year-old man with chronic posttraumatic aneurysm. Helical CT scan (B) and multiplanar reconstructed CT image (C) obtained 1 year after stent-graft placement show complete aneurysm exclusion with no significant shrinkage. Note linear calcification of adventitial wall.

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