Post-traumatic lesions of the aortic isthmus

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COD: 089-100 Categorie: ,

Stefano Maria Giulini, Stefano Bonardelli

Ann. Ital. Chir., 80, 1, 2009

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Lesions of the isthmus are the most frequent among post-traumatic lesions of the thoracic aorta (LTA): almost always
secondary to closed thoracic traumas (road accidents, falls, crushing, and explosions), they are rarely iatrogenic (operatory
catheterisms) or caused by penetrating wounds. In the review of the literature concerned in the report, from the analysis
of 89 bibliographic sources, we note that the etiopathogenesis and the pathophysiology of the LTA still entail a very
high immediate mortality, but we also note that, in recent years, remarkable improvements have been made not only in
prevention, first-aid, diagnostic definition and in the understanding of the development of the LTA, but above all in
therapeutic results. The correct use of the conservative approach, particularly in the immediately post-traumatic phases,
the increasingly wide-spread use of endovascular exclusion (T-EVAR), even if not without numerous technical difficulties,
and the further improvement of open surgery, currently make it possible to guarantee the individual patient the treatment
that can offer the best probabilities of success, at least immediately. Final development, and a more complete and
rigorous assessment of the medium and long term results of TEVAR will allow the formulation of therapeutic strategies
that are even better defined and increasingly simple to implement, on the basis of algorithms, such as the one proposed
by the Authors.

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