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Letters to the Editor |
Department of Cardiovascular and Thoracic Surgery, Deutsches Herzzentrum Berlin, Germany
Received 29 April 2008; accepted 30 April 2008.
* Corresponding author. Address: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel.: +49 30 4593 1938; fax: +49 30 4593 2100. (Email: buz{at}dhzb.de).
Key Words: Traumatic aortic rupture • Endovascular stent-grafting • Conventional repair
Thank you for your interest in our paper and your comments [1].
We compared two different techniques for the treatment of acute traumatic aortic rupture in terms of outcome. Patients came from two level 1 trauma centers in Berlin and were referred to our institution when traumatic aortic injury was suspected or recognized. We are therefore not able to discuss what the author's term ‘asymptomatic’ patients. There is general agreement concerning the necessity of surgery in acute traumatic aortic rupture, but the timing of repair is still a matter of controversy. Parmley et al. reported that those patients reaching the hospital alive are exposed to a constant threat of dying from a second rupture during the following hours and days [2]. We have found that free rupture can occur and cause the death of a patient even during a short period of waiting [3]. We suggest operation of the rupture directly after its diagnosis, assuming that other actively bleeding injuries are controlled.
In our view, the question about the diagnostic method in patients with traumatic aortic rupture is clarified: spiral CT angiography should be the first test for diagnosis. We believe that aortography is not always necessary for preoperative diagnostics. Aortography is accomplished intraoperatively to localize the rupture before stent-graft implantation. In the treatment of traumatic aortic rupture, some issues remain unsolved, and these are discussed in our paper [4]. In many cases overstenting of the left subclavian artery is necessary to ensure fixation of the stent-graft. Anatomically, patients with a rupture in the aortic arch, above the left subclavian artery, or in the ascending aorta, which is rare in traumatic aortic rupture, are not candidates for stent-grafting. For emergency stent-graft treatment, a stock of stent-grafts in the hospital is necessary. Since patients with traumatic aortic rupture are usually young patients with relatively small aortic diameter, a stock of stent-grafts with a diameter starting from 20 mm is helpful.
References
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