Astarci P, Lacroix V, Glineur D, Poncelet A, Rubay J, El Khoury G, Noirhomme P, Verhels R
Cardiovascular Surgery Department, Saint-Luc University Hospital, Brussels, Belgium.
Ann Vasc Surg. 2009 Sep-Oct;23(5):634-8. doi: 10.1016/j.avsg.2009.03.001. Epub 2009 May 21.
We evaluated midterm results of endovascular management of traumatic aortic isthmic ruptures.
Between 2001 and 2008, 10 patients (seven males, mean age 38 years) underwent endovascular treatment of an acute aortic rupture. Eight procedures were emergent, with four cases of hemodynamic instability with Glasgow scores of 3, 5, and 7. Associated traumas were severe brain, liver, and pelvic bone injuries. All procedures were performed with transoesophageal echocardiography monitoring. We used two AneuRx and nine Medtronic Talent or Valiant stent grafts.
All patients survived their traumatic isthmic rupture. In nine patients, stent-graft deployment was successful. One patient experienced a distal migration needing a laparotomy and deployment of an additional new thoracic stent graft. The mean intensive care unit stay was 48 hr (range 24-168). The mean hospital stay was 11 days (range 8-43). All patients were controlled clinically and by contrast computed tomography (CT) according to the EUROSTAR protocol. There were no endoleaks, stent graft-related complications, or late deaths during a mean follow-up of 49 months. The control CT showed a lack of apposition of the proximal part of the stent graft at the inner curve of the aortic arch in three patients.
The midterm results of endovascular treatment of acute traumatic aortic isthmic rupture are encouraging and compare favorably to the surgical approach. Late follow-up is required to exclude possible stent-graft complications, especially in young patients with angulated aortic arches.
我们评估了创伤性主动脉峡部破裂血管内治疗的中期结果。
2001年至2008年期间，10例患者（7例男性，平均年龄38岁）接受了急性主动脉破裂的血管内治疗。8例手术为急诊手术，4例患者存在血流动力学不稳定，格拉斯哥评分分别为3分、5分和7分。合并有严重的脑、肝和骨盆骨损伤。所有手术均在经食管超声心动图监测下进行。我们使用了2个AneuRx支架和9个美敦力Talent或Valiant覆膜支架。
所有患者均在创伤性峡部破裂后存活。9例患者覆膜支架置入成功。1例患者发生远端移位，需要开腹手术并额外置入一个新的胸段覆膜支架。重症监护病房平均住院时间为48小时（范围24 - 168小时）。平均住院时间为11天（范围8 - 43天）。所有患者均按照欧洲血管内支架治疗登记（EUROSTAR）方案进行临床和对比计算机断层扫描（CT）检查。在平均49个月的随访期间，未发现内漏、覆膜支架相关并发症或晚期死亡病例。对照CT显示，3例患者的覆膜支架近端在内侧主动脉弓曲线上未完全贴合。
急性创伤性主动脉峡部破裂血管内治疗的中期结果令人鼓舞，与手术治疗方法相比具有优势。需要进行长期随访以排除可能的覆膜支架并发症，尤其是在主动脉弓成角的年轻患者中。
