Cincinnati surgeons report new treatment for often-fatal injury

CINCINNATI--University of Cincinnati (UC) surgeons have developed a new, minimally invasive method for repairing a common and deadly form of aortic injury--an advance that could help reduce the number of deaths caused by auto accidents and major falls.

The potentially life-saving technique is reported by Joseph Giglia, MD, interim director of UC's division of vascular surgery, and his team in the March edition of Annals of Vascular Surgery.

Dr. Giglia estimates that 80 to 90 percent of the patients who suffer this injury--known as blunt thoracic aortic trauma--die before ever reaching a hospital.

The aorta is the main artery that carries oxygenated blood from the heart to be distributed throughout the body.

A severe blunt thoracic accident, usually a non-penetrating "deceleration" injury, 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 does rupture, killing the patient.

The Food and Drug Administration has yet to approve a device for treatment of this type of injury, says Dr. Giglia, and custom-made devices are usually large and difficult to use in an emergency setting.

Dr. Giglia's team 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 (endografts) they could effectively protect the damaged area without stopping blood flow to the rest of the body.

The endografts are regularly used in vascular surgery to treat aneurysms in the abdomen, Dr. Giglia explains, but they are too short to fully bridge the damaged area in the chest.

"Used alone, extender cuffs are hard to align and often slip into the defect to cause further complications," says Dr. Giglia. "Using a fixed stent provides an easy-to-see 'scaffolding' that can guide the surgeon to more accurately secure the extender cuffs and create a strong seal."

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.

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

Standard "open" treatment for this type of injury can work, says Dr. Giglia, but it puts significant stress on the patient's heart and brain and increases the risk for heart attack, bleeding, paraplegia and other problems.

J. Keith Thompson, DO, and Amy Reed, MD, both of UC, were coauthors on this study.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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