创伤性胸主动脉损伤的血管内治疗
Endovascular management of traumatic thoracic aortic injuries.
作者信息
Lawlor D Kirk, Ott Michael, Forbes Thomas L, Kribs Stewart, Harris Kenneth A, DeRose Guy
机构信息
Division of Vascular Surgery, University of Western Ontario, London, ON.
出版信息
Can J Surg. 2005 Aug;48(4):293-7.
BACKGROUND
Endovascular surgery has recently been extended to the treatment of blunt traumatic aortic injuries. Since most of these injuries occur at the aortic isthmus, graft fixation in proximity to the origin of the left subclavian artery (LSA) has been a concern. Covering the LSA with graft fabric lengthens the proximal fixation site and should minimize proximal endoleaks. We therefore wished to evaluate the feasibility and safety of endovascular repair of thoracic aortic injuries after blunt trauma, both with and without deliberate coverage of the LSA.
METHODS
At a tertiary care teaching hospital in London, Ont., we reviewed our experience with endovascular repair of 7 traumatic aortic injuries. We reviewed the technical success rate and the incidence of left subclavian coverage. Major morbidity, including rates of paraplegia and death were noted. The patients were followed-up with serial CT to look for endoleaks, stent migration or aneurysm growth and to determine whether they had symptoms related to left subclavian coverage.
RESULTS
The time from injury to treatment ranged from 7 hours to 7 days (mean 36 h). The mean Injury Severity Score was 36. All injuries were at the aortic isthmus, and among the 7 patients treated, 6 had deliberate coverage of the LSA. One patient underwent carotid-to-subclavian artery bypass, but the other 5 did not. There were no cases of paraplegia; 1 patient had symptoms of claudication in the left arm but did not want revascularization. No procedure-related complications occurred, and all patients survived the event. Follow-up ranged from 2 to 30 (mean 13) months, and no endoleaks, stent migration or aneurysm expansion were noted in follow-up.
CONCLUSIONS
Although long-term results are unknown, we conclude that endovascular repair of traumatic aortic injuries after blunt trauma can be performed safely with low morbidity and mortality and that coverage of the LSA without revascularization is tolerated by most patients.
背景
血管内手术最近已扩展至钝性创伤性主动脉损伤的治疗。由于这些损伤大多发生在主动脉峡部，因此在左锁骨下动脉（LSA）起源附近进行移植物固定一直是个问题。用移植物织物覆盖LSA可延长近端固定部位，并应能最大程度减少近端内漏。因此，我们希望评估钝性创伤后胸主动脉损伤血管内修复的可行性和安全性，包括是否故意覆盖LSA。
方法
在安大略省伦敦市的一家三级护理教学医院，我们回顾了7例创伤性主动脉损伤血管内修复的经验。我们回顾了技术成功率和左锁骨下动脉覆盖的发生率。记录了主要并发症的发生率，包括截瘫和死亡率。对患者进行系列CT随访，以寻找内漏、支架移位或动脉瘤生长情况，并确定他们是否有与左锁骨下动脉覆盖相关的症状。
结果
从受伤到治疗的时间为7小时至7天（平均36小时）。平均损伤严重度评分为36分。所有损伤均位于主动脉峡部，在接受治疗的7例患者中，6例故意覆盖了LSA。1例患者接受了颈动脉至锁骨下动脉搭桥手术，其余5例未进行。无截瘫病例；1例患者左臂有间歇性跛行症状，但不希望进行血运重建。未发生与手术相关的并发症，所有患者均在此次事件中存活。随访时间为2至30个月（平均13个月），随访期间未发现内漏、支架移位或动脉瘤扩大。
结论
尽管长期结果尚不清楚，但我们得出结论，钝性创伤后创伤性主动脉损伤的血管内修复可以安全进行，发病率和死亡率较低，并且大多数患者可以耐受不进行血运重建的LSA覆盖。
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