Department of Surgery, University of Michigan Hospitals, Ann Arbor, Mich, USA.
J Vasc Surg. 2011 Mar;53(3):615-20; discussion 621. doi: 10.1016/j.jvs.2010.09.058. Epub 2010 Dec 13.
Previous studies have focused on early outcomes of open (descending thoracic aortic repair [DTAR]) and endovascular (thoracic endovascular aneurysm repair [TEVAR]) repair of blunt aortic injury (blunt thoracic aortic injury [BTAI]). Late results remain ill-defined and are the focus of this study.
One hundred nine patients (1992-2010) underwent repair for BTAI. Mean age was 39.0 years (73.4% male). DTAR was performed in 90, with left heart bypass (85) or hypothermic arrest (5). TEVAR was used in 19 of 45 patients treated since 2002. A strategy of selective delayed repair has been used since 1997, with 54 of 75 patients treated with delayed repair in this interval. The primary outcome was vital status (100% follow-up; mean, 103.9 months).
Mean Injury Severity Score was 39.5. Thirty-day mortality was 4.6% (n = 5). Early morbidity included permanent spinal cord ischemia (SCI, 1.8%), stroke (2.8%), and need for permanent dialysis (1.8%). Independent predictors of a composite outcome of early mortality and these morbidities included age >60 years (odds ratio [OR], 8.4; P = .015), increasing preoperative creatinine (OR, 7.9; P = .017), and occurrence of postoperative sepsis (OR, 9.6; P = .021). Fifteen-year Kaplan-Meier survival was 81.3%. Independent predictors of late mortality included age >60 years (Cox hazard ratio [HR], 4.1; P = .01), increasing creatinine (HR, 9.1; P < .001), or occurrence of postoperative SCI (HR, 20.6; P < .001), but not repair type (P = .73). Endograft collapse occurred in one patient, necessitating reintervention. Freedom from aortic reintervention at 4 years was higher after open repair (DTAR 100% vs TEVAR 94%; P = .03).
With careful selection, open or endovascular repair of BTAI has excellent early and late results. Although TEVAR has an increased risk for reintervention, factors other than treatment strategy impact late survival. These data support the growing role of an endoluminal approach for BTAI in anatomically appropriate patients.
先前的研究集中于开放性（降主动脉修复术 [DTAR]）和血管内（胸主动脉腔内修复术 [TEVAR]）修复钝性主动脉损伤（钝性胸主动脉损伤 [BTAI]）的早期结果。晚期结果仍不明确，这是本研究的重点。
109 例患者（1992-2010 年）因 BTAI 接受了修复治疗。平均年龄为 39.0 岁（73.4%为男性）。90 例行 DTAR，其中 85 例行左心旁路（LHB），5 例行低温停循环。2002 年后，19 例患者采用 TEVAR 治疗。自 1997 年以来，采用了选择性延迟修复策略，在此期间，75 例患者中有 54 例接受了延迟修复。主要结局是生存状态（100%随访；平均 103.9 个月）。
平均损伤严重程度评分 39.5 分。30 天死亡率为 4.6%（n=5）。早期发病率包括永久性脊髓缺血（SCI，1.8%）、中风（2.8%）和需要永久性透析（1.8%）。早期死亡率和这些发病率的复合结果的独立预测因素包括年龄>60 岁（比值比 [OR]，8.4；P=0.015）、术前血肌酐升高（OR，7.9；P=0.017）和术后脓毒症（OR，9.6；P=0.021）。15 年的 Kaplan-Meier 生存率为 81.3%。晚期死亡率的独立预测因素包括年龄>60 岁（Cox 风险比 [HR]，4.1；P=0.01）、血肌酐升高（HR，9.1；P<0.001）或术后 SCI（HR，20.6；P<0.001），但与治疗方式无关（P=0.73）。1 例患者发生移植物塌陷，需要再次干预。4 年时开放修复（DTAR 100% vs TEVAR 94%；P=0.03）的主动脉再次干预率更高。
经过精心选择，开放性或血管内修复 BTAI 具有良好的早期和晚期结果。尽管 TEVAR 有更高的再次干预风险，但除了治疗策略外，其他因素也会影响晚期生存。这些数据支持在解剖学合适的患者中采用腔内方法治疗 BTAI 的作用不断增强。
