Duwayri Yazan, Abbas Jihad, Cerilli Gregory, Chan Edwin, Nazzal Munier
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA.
Ann Vasc Surg. 2008 May-Jun;22(3):309-13. doi: 10.1016/j.avsg.2007.09.012. Epub 2008 Apr 14.
Traumatic rupture of the thoracic aorta is a potentially fatal injury that leads to death in 75-90% of cases at the time of injury. In this report, we present our experience with traumatic thoracic aortic injury and compare the outcome in patients with respect to their hemodynamic stability at presentation and the timing of surgical repair. We performed a retrospective data analysis of the medical records of 30 patients who had sustained a traumatic rupture of the thoracic aorta during the period from January 1, 2000 to October 30, 2005. The demographic data, mechanism of injury, modality of diagnosis, location of injury, other associated injuries, hemodynamic stability at presentation, response to resuscitation, timing of aortic repair, as well as the resultant morbidities and mortalities were reviewed. Traumatic rupture of the thoracic aorta was diagnosed in 30 patients. The injury was located in the ascending aorta in two patients, in the aortic isthmus in 25 patients, and in the descending aorta (distal to the isthmus) in three patients. Associated injuries included head injury (50%), C spine (23.3%), lung injury (80%), and visceral (63%) and extremity (60%) injury. Seven patients (23%) were pronounced dead on arrival to the emergency room, 14 patients (47%) were hemodynamically unstable upon arrival, and nine patients (30%) were hemodynamically stable. In the unstable group, two patients (14%) expired before operative repair, 11 patients (79%) underwent emergent repair of the thoracic aorta resulting in 46% mortality, and one patient (7%) underwent delayed repair after initial stabilization with a splenectomy for a splenic laceration. In the stable group, three patients (33%) underwent early (within 24 hr) aortic surgery, while repair was delayed in six (67%). The mean duration of time spent prior to delayed repair was 20.85 days (range 2-53, median = 25). There was no mortality in this group. Acute traumatic thoracic aortic rupture remains a highly fatal condition. Hemodynamic instability remains the main mortality risk factor. Delayed repair is safe and is not associated with increased risk of aortic rupture in hemodynamically stable patients.
创伤性胸主动脉破裂是一种潜在的致命性损伤，在受伤时75% - 90%的病例会导致死亡。在本报告中，我们介绍了我们在创伤性胸主动脉损伤方面的经验，并比较了患者就诊时的血流动力学稳定性和手术修复时机对预后的影响。我们对2000年1月1日至2005年10月30日期间30例发生创伤性胸主动脉破裂患者的病历进行了回顾性数据分析。回顾了人口统计学数据、损伤机制、诊断方式、损伤部位、其他相关损伤、就诊时的血流动力学稳定性、复苏反应、主动脉修复时机以及由此产生的发病率和死亡率。30例患者被诊断为创伤性胸主动脉破裂。损伤位于升主动脉2例，主动脉峡部25例，降主动脉（峡部远端）3例。相关损伤包括头部损伤（50%）、颈椎损伤（23.3%）、肺损伤（80%）、内脏损伤（63%）和肢体损伤（60%）。7例患者（23%）到达急诊室时被宣布死亡，14例患者（47%）到达时血流动力学不稳定，9例患者（30%）血流动力学稳定。在不稳定组中，2例患者（14%）在手术修复前死亡，11例患者（79%）接受了胸主动脉急诊修复，死亡率为46%，1例患者（7%）在因脾破裂行脾切除初步稳定后接受了延迟修复。在稳定组中，3例患者（33%）接受了早期（24小时内）主动脉手术，6例患者（67%）手术延迟。延迟修复前的平均时间为20.85天（范围2 - 53天，中位数 = 25天）。该组无死亡病例。急性创伤性胸主动脉破裂仍然是一种高度致命的疾病。血流动力学不稳定仍然是主要的死亡风险因素。对于血流动力学稳定的患者，延迟修复是安全的，且与主动脉破裂风险增加无关。
