Hoffer Eric K, Forauer Andrew R, Silas Anne M, Gemery John M
Dartmouth Medical School and the Department of Radiology, Section of Vascular and Interventional Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
J Vasc Interv Radiol. 2008 Aug;19(8):1153-64. doi: 10.1016/j.jvir.2008.05.012. Epub 2008 Jun 27.
To evaluate the available data on stent-graft repair of acute blunt traumatic thoracic aortic injury with regard to safety and efficacy compared with conventional open surgical repair.
The literature on endovascular repair of acute traumatic aortic injury since 1990 was systematically reviewed. Metaanalysis of publications with open and stent-graft repair cohorts was performed to evaluate whether there was a difference in treatment effect with regard to mortality and paraplegia. Case series were included to obtain an adequate population to assess the incidence of stent-graft procedure-related complications.
There were no prospective randomized studies. Nineteen publications that compared the outcomes of 262 endograft repairs and 376 open surgical repairs were identified. The odds ratio for mortality after endovascular versus open repair was 0.43 (95% CI, 0.26-0.70; P = .001). The odds ratio for paraplegia after endovascular versus open repair was 0.30 (95% CI, 0.12-0.76; P = .01). In the pooled group of 667 endovascular repair survivors from 50 reports, the incidence of early endoleak was 4.2%, and late endoleak occurred in 0.9%. Stroke or transient ischemic attack was reported in 1.2%. Access site complications that required intervention occurred in 4.1%.
The available cohort and case series data support stent-graft repair as a highly successful technique that may reduce mortality and paraplegia rates by half compared with open surgery. These data support endograft repair as first-line therapy for blunt thoracic aortic trauma.
评估与传统开放性手术修复相比，急性钝性创伤性胸主动脉损伤的支架型人工血管修复在安全性和有效性方面的现有数据。
系统回顾了自1990年以来急性创伤性主动脉损伤的血管内修复文献。对开放性手术修复组和支架型人工血管修复组的出版物进行荟萃分析，以评估在死亡率和截瘫方面治疗效果是否存在差异。纳入病例系列以获得足够的人群来评估支架型人工血管手术相关并发症的发生率。
没有前瞻性随机研究。确定了19篇比较262例血管内修复和376例开放性手术修复结果的出版物。血管内修复与开放性修复后死亡率的比值比为0.43（95%可信区间，0.26 - 0.70；P = 0.001）。血管内修复与开放性修复后截瘫的比值比为0.30（95%可信区间，0.12 - 0.76；P = 0.01）。在来自50份报告的667例血管内修复幸存者的汇总组中，早期内漏发生率为4.2%，晚期内漏发生率为0.9%。有1.2%的患者报告发生中风或短暂性脑缺血发作。需要干预的穿刺部位并发症发生率为4.1%。
现有的队列和病例系列数据支持支架型人工血管修复是一种非常成功的技术，与开放性手术相比，可将死亡率和截瘫率降低一半。这些数据支持将血管内修复作为钝性胸主动脉创伤的一线治疗方法。
