Urgnani Francesca, Lerut Philip, Da Rocha Marcio, Adriani Domingo, Leon Fernando, Riambau Vicente
Vascular Surgery Division of the Thorax Institute, Hospital Clinic, Barcelona, Spain.
J Thorac Cardiovasc Surg. 2009 Nov;138(5):1129-38. doi: 10.1016/j.jtcvs.2008.10.057. Epub 2009 Jun 13.
We report our 10-year experience in the endovascular treatment of acute traumatic thoracic aorta rupture at the Hospital Clinic.
We reviewed 20 patients with an acute traumatic thoracic aorta lesion treated with a thoracic endograft between August 1997 and July 2007. All patients had multi-trauma resulting from high-velocity accidents or accidents with great impact. The diagnosis of aortic injury was made on a clinical basis and conventional imaging, confirmed by computed tomographic angiography. The following parameters were studied: age, sex, type and site of the lesion, type of endovascular graft, endovascular operation time, length of stay in the intensive care unit, length of stay in the hospital, immediate and perioperative complications, and mortality. Follow-up data were recorded, consisting of clinical visits, computed tomographic angiography, and plain chest radiographs at regular intervals (3, 6, and 12 months and every subsequent year). The mean follow-up was 58 months.
All endovascular procedures were technically successful, and the mean operating time for the endovascular procedure was 74 minutes (range, 55-130 minutes). We recorded an external iliac lesion during the procedure as an unique immediate complication, and it was corrected by an iliofemoral bypass. The only perioperative death (perioperative mortality rate of 5%) was unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during the follow-up. Postoperative data showed no severe endovascular graft- or procedure-related morbidity. We recorded 2 cases of stent fracture, diagnosed by chest radiograph and computed tomographic angiography, without clinical impact or signs of endoleak.
The short- and mid-term results of immediate endovascular repair of traumatic aortic injuries are promising, especially when compared with open surgical treatment, indicating that endovascular therapy is preferable in patients with multi-trauma and traumatic ruptures of the thoracic aorta. Nevertheless, long-term follow-up data are necessary to assess the overall durability of this procedure, considering the young age of these patients. The long-term follow-up results will determine whether endovascular treatment should replace open surgery as first-line therapy in thoracic aortic injuries.
我们报告在医院诊所对急性创伤性胸主动脉破裂进行血管内治疗的10年经验。
我们回顾了1997年8月至2007年7月间20例接受胸段血管内移植物治疗的急性创伤性胸主动脉病变患者。所有患者均因高速事故或重大撞击事故导致多发伤。主动脉损伤的诊断基于临床和传统影像学检查，并经计算机断层血管造影证实。研究了以下参数：年龄、性别、病变类型和部位、血管内移植物类型、血管内手术时间、重症监护病房住院时间、住院时间、即刻和围手术期并发症以及死亡率。记录随访数据，包括定期（3、6和12个月以及随后每年）的临床检查、计算机断层血管造影和平片胸部X线片。平均随访时间为58个月。
所有血管内手术在技术上均获成功，血管内手术的平均操作时间为74分钟（范围为55 - 130分钟）。我们将手术过程中记录的髂外病变作为唯一的即刻并发症，并通过髂股旁路手术进行了纠正。唯一的围手术期死亡（围手术期死亡率为5%）与主动脉破裂或支架置入无关。随访期间无干预相关死亡。术后数据显示无严重的血管内移植物或手术相关并发症。我们记录了2例支架骨折，通过胸部X线片和计算机断层血管造影诊断，无临床影响或内漏迹象。
创伤性主动脉损伤即刻血管内修复的短期和中期结果很有前景，尤其是与开放手术治疗相比，这表明血管内治疗对于多发伤和胸主动脉创伤性破裂患者更为可取。然而，考虑到这些患者年龄较轻，需要长期随访数据来评估该手术的整体耐久性。长期随访结果将决定血管内治疗是否应取代开放手术成为胸主动脉损伤的一线治疗方法。
