Karmy-Jones Riyad, Ferrigno Lisa, Teso Desarom, Long William B, Shackford Steven
Heart and Vascular Center and Section of Trauma, Southwest Washington Medical Center, Vancouver, Washington 98664, USA.
J Trauma. 2011 Oct;71(4):1059-72. doi: 10.1097/TA.0b013e3182288783.
Thoracic endovascular aortic repair (TEVAR) has become the preferred intervention for managing traumatic thoracic aortic injury. The literature suggests that TEVAR is associated with reduced mortality and paraplegia compared with open repair (OR). The lack of guidelines for reporting results and the paucity of patient follow-up make interpretation of the literature difficult.
A literature review of English language papers on thoracic aortic trauma published between 2005 and 2010 was performed. Papers were analyzed to determine how many commented on injury data known to affect outcome (age, hemodynamic stability, injury severity, degree of aortic injury, etc.).
Sixty-two retrospective reviews and six meta-analysis papers were identified. Of the review papers, only 6.4% described aortic anatomy using standard criteria, only 25.8% reported the degree of aortic injury, only 19.4% defined early or emergent intervention, only 32.3% provided details regarding hemodynamic stability, and only 56.5% described injury severity by Injury Severity Score. In a subset analysis of papers containing trauma relevant data, comparing TEVAR with OR, the TEVAR population was older, whereas the OR group was more often unstable. TEVAR had a significantly lower mortality, a trend to reduction in paralysis, but a significantly increased stroke rate. Follow-up was minimal in both groups.
The lack of reporting guidelines coupled with a paucity of follow-up data weakens any recommendation regarding the optimal choice of intervention. To address these deficiencies, we recommend reporting guidelines specific to the trauma population that will allow better risk adjustment and improve the quality of the evidence base.
胸主动脉腔内修复术（TEVAR）已成为治疗创伤性胸主动脉损伤的首选干预措施。文献表明，与开放修复术（OR）相比，TEVAR与降低死亡率和截瘫发生率相关。缺乏结果报告指南以及患者随访数据的匮乏使得对文献的解读变得困难。
对2005年至2010年间发表的关于胸主动脉创伤的英文论文进行文献综述。分析论文以确定有多少篇对已知影响预后的损伤数据（年龄、血流动力学稳定性、损伤严重程度、主动脉损伤程度等）进行了评论。
共识别出62篇回顾性综述和6篇荟萃分析论文。在这些综述论文中，只有6.4%使用标准标准描述主动脉解剖结构，只有25.8%报告主动脉损伤程度，只有19.4%定义早期或紧急干预，只有32.3%提供了关于血流动力学稳定性的详细信息，只有56.5%通过损伤严重程度评分描述损伤严重程度。在包含创伤相关数据的论文子集分析中，将TEVAR与OR进行比较，TEVAR组患者年龄较大，而OR组患者更常处于不稳定状态。TEVAR的死亡率显著较低，有截瘫发生率降低的趋势，但中风发生率显著增加。两组的随访都很少。
缺乏报告指南以及随访数据的匮乏削弱了关于最佳干预选择的任何建议。为解决这些不足，我们建议制定针对创伤人群的报告指南，这将有助于更好地进行风险调整并提高证据基础的质量。
