Minimally invasive repair of an aortic tear may have a higher survival rate than traditional open surgery

Minimally invasive repair of an aortic tear may have a higher survival rate than traditional open surgery, according to a presentation at the nineteenth International Symposium on Endovascular Therapy.

Injury to the aorta is the second most common cause of death from a motor vehicle accident or fall. Of every 10 people who have this type of injury, 9 bleed to death at the accident scene. Many of those who reach the hospital die because open-chest surgery is too risky when compounded by other serious injuries. Minimally invasive repair of the tear with an endograft, a fabric tube supported by a stent, is less risky because it can be done without opening the chest.

In the study, 100 percent of trauma patients who underwent minimally invasive endograft repair survived, whereas 31 percent of patients who had open-chest surgical repair died.

"Many of these typically young and otherwise healthy people die of aorta injuries after reaching the hospital because their bodies haven't stabilized enough to undergo surgery," said Oren Steinmetz, MD, associate professor, McGill University Health Center, in Montreal. "Placing an endograft allows us to correct a life-threatening problem sooner and in a far less invasive and less dangerous way. Then we can also more easily treat the other injuries."

The study included 28 patients diagnosed with blunt thoracic aortic injury who were treated at McGill University Health Center; 16 were treated with open surgery and 12 were treated with minimally invasive endograft repair. In the surgical group, 5 patients died (31 percent), one suffered paraplegia (6 percent) and one underwent repeat surgery for excessive bleeding (6 percent). In the endograft group, no patients died, suffered paraplegia or had to undergo a second procedure.

"Our early study suggests that endograft repair is likely to be more successful than surgery in these patients," said Steinmetz. "At our institution, all patients with this type of injury are now offered this alternative to surgery whenever possible."


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