Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Clinics (Sao Paulo). 2011;66(2):267-74. doi: 10.1590/s1807-59322011000200015.
The objective of this retrospective study is to analyze and compare the results of conventional surgical repair and endovascular treatment of blunt aortic injury over the past 8 years.
Twenty-eight patients (25 male; mean age, 35 years) were treated for blunt aortic injury between April 2001 and March 2009 in a university hospital in Brazil. Twenty-six patients were included in the study: five were treated with operative repair (OR) and 21 with endovascular treatment (TEVAR). Two patients were excluded from analysis: one was managed conservatively, and one was treated with endovascular treatment for chronic dissection related to aortic trauma.
Mean age was lower in the OR group than in the endovascular treatment group (17.8 vs. 38 years, P = .003). There was one death in the OR group and four deaths in the endovascular treatment group. Mean follow-up for the overall group was 33.6 months, with 48.7 months (range 8-83 months) for the OR group, and 29.8 months (range 2-91 months) for the TEVAR group. Mean time elapsed from injury to repair was 23.4 hours (range 8-48 h, median 20 h) for the OR group and 30.3 hours (range 2-240 h, median 18 h) for the TEVAR group (P = .374). The duration of surgery was shorter in the endovascular treatment group (142 versus 237 minutes; P = .005). There were no significant differences with respect to the number of postoperative days requiring mechanical ventilation, duration of ICU stay or duration of hospital stay.
In this retrospective analysis, endovascular treatment was a safe method for repair of blunt aortic trauma, with immediate and midterm results that were comparable to those results obtained with operative repair. No complications from the stent graft were identified during follow-up. Nevertheless, long-term follow-up is necessary to confirm the effectiveness of this treatment.
本回顾性研究旨在分析和比较过去 8 年中传统手术修复与血管内治疗钝性主动脉损伤的结果。
2001 年 4 月至 2009 年 3 月期间，巴西某大学医院对 28 例钝性主动脉损伤患者进行治疗。其中 26 例患者纳入研究：5 例采用手术修复（OR），21 例采用血管内治疗（TEVAR）。2 例患者被排除在分析之外：1 例采用保守治疗，1 例因与主动脉创伤相关的慢性夹层而行血管内治疗。
OR 组的平均年龄低于血管内治疗组（17.8 岁比 38 岁，P =.003）。OR 组有 1 例死亡，血管内治疗组有 4 例死亡。总的平均随访时间为 33.6 个月，OR 组为 48.7 个月（范围 8-83 个月），TEVAR 组为 29.8 个月（范围 2-91 个月）。OR 组从损伤到修复的平均时间为 23.4 小时（范围 8-48 小时，中位数 20 小时），TEVAR 组为 30.3 小时（范围 2-240 小时，中位数 18 小时）（P =.374）。血管内治疗组的手术时间更短（142 分钟比 237 分钟；P =.005）。两组术后需要机械通气的天数、ICU 住院时间和住院时间均无显著差异。
在这项回顾性分析中，血管内治疗是治疗钝性主动脉创伤的一种安全方法，即时和中期结果与手术修复相当。在随访期间未发现支架移植物的并发症。然而，需要长期随访来确认这种治疗方法的有效性。
