Section of Vascular Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, CT 06510, USA.
Eur J Vasc Endovasc Surg. 2010 Nov;40(5):564-71. doi: 10.1016/j.ejvs.2010.07.014. Epub 2010 Aug 19.
To investigate the impact of hypovolaemic shock on the aortic diameter in a porcine model, and to determine the implications for the endovascular management of hypovolaemic patients with traumatic thoracic aortic injury (TTAI).
The circulating blood volume of seven Yorkshire pigs was gradually lowered in 10% increments. At 40% volume loss, an endograft was deployed in the descending thoracic aorta, followed by gradual fluid resuscitation. Potential changes in aortic diameter during the experiment were recorded using intravascular ultrasound (IVUS).
The aortic diameter decreased significantly at all evaluated levels during blood loss. The ascending aortic diameter decreased on average with 38% after 40% blood loss (range 24-62%, p = 0.018), the descending thoracic aorta with 32% (range 18-52%, p = 0.018) and the abdominal aorta with 28% (range 15-39%, p = 0.018). The aortic diameters regained their initial size during fluid resuscitation.
The aortic diameter significantly decreases during blood loss in this porcine model. If these changes take place in hypovolaemic TTAI patients as well, it may have implications for thoracic endovascular aortic repair (TEVAR). Increased oversizing of the endograft, or additional computed tomography (CT) or IVUS imaging after fluid resuscitation for more adequate aortic measurements, may be needed in TTAI patients with considerable blood loss.
探讨失血性休克对猪模型主动脉直径的影响，并确定其对创伤性胸主动脉损伤（TTAI）伴失血性休克患者血管内治疗的影响。
逐渐降低 7 头约克夏猪的循环血量，每次降低 10%。在 40%的容量损失时，在降主动脉中部署一个血管内移植物，然后逐渐进行液体复苏。使用血管内超声（IVUS）记录实验过程中主动脉直径的潜在变化。
在失血过程中，所有评估水平的主动脉直径均显著减小。在 40%的血液丢失后，升主动脉直径平均减小 38%（范围 24-62%，p=0.018），降主动脉直径减小 32%（范围 18-52%，p=0.018），腹主动脉直径减小 28%（范围 15-39%，p=0.018）。在液体复苏过程中，主动脉直径恢复到初始大小。
在该猪模型中，失血过程中主动脉直径显著减小。如果这些变化也发生在失血性 TTAI 患者中，可能对胸主动脉腔内修复（TEVAR）有影响。在大量失血的 TTAI 患者中，可能需要增加移植物的过度扩张，或在液体复苏后进行额外的 CT 或 IVUS 成像，以进行更充分的主动脉测量。
