Kolbeck Kenneth J, Kaufman John A
Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon.
Semin Intervent Radiol. 2011 Mar;28(1):98-106. doi: 10.1055/s-0031-1273944.
A traumatic thoracic aortic injury is fatal in the majority of cases. Surviving the aortic injury in addition to the myriad of associated trauma requires comprehensive medical management from many medical services. Balancing these services and coordinating the medical care requires free and open communication between services. Although one might assume a thoracic aortic injury takes precedence over other injuries, an organized plan of care in which the morbidity of the injury as well as the consequences of treatment of each injury helps provide an appropriate "rank order" in the treatment process. A patient with a thoracic aortic injury can be observed for several days while additional injuries are treated, as long as appropriate blood pressure controls are observed. The treatment order for multiple injuries must be reevaluated on a regular basis to adjust for changes in the overall clinical condition. This rank order to treatment and scheduled treatment plan allows for appropriate imaging, evaluation, and coordination of services in preparation for the placement of a thoracic aortic stent graft. The goal of treatment is to reduce the risk of aortic rupture and subsequent fatal hemorrhage. Choosing an open surgical repair versus an endovascular stent graft depends upon physician expertise and clinical status of the patient. In the appropriate clinical setting, endovascular repair of the thoracic aortic injury has become the treatment of choice at the authors' institution in patients with significant operative risks and extensive comorbid injuries. Specific characteristics of the injured aorta also dictate the type of endovascular device required for repair. Case reviews of a patient with blunt trauma and a patient with penetrating trauma used to demonstrate clinical parameters, imaging options, and details of stent graft choice and placement, are presented followed by a review of the literature.
创伤性胸主动脉损伤在大多数情况下是致命的。除了众多相关创伤外，要在主动脉损伤中存活下来需要众多医疗服务进行全面的医疗管理。平衡这些服务并协调医疗护理需要各服务部门之间自由且开放的沟通。尽管有人可能认为胸主动脉损伤比其他损伤更优先，但一个有组织的护理计划，其中损伤的发病率以及每种损伤的治疗后果有助于在治疗过程中提供适当的“优先顺序”。只要观察到适当的血压控制，胸主动脉损伤患者在治疗其他损伤时可以观察数天。必须定期重新评估多种损伤的治疗顺序，以适应整体临床状况的变化。这种治疗的优先顺序和预定的治疗计划允许进行适当的成像、评估和服务协调，为放置胸主动脉支架移植物做准备。治疗的目标是降低主动脉破裂及随后致命出血的风险。选择开放手术修复还是血管内支架移植物取决于医生的专业知识和患者的临床状况。在适当的临床环境中，胸主动脉损伤的血管内修复已成为作者所在机构对具有重大手术风险和广泛合并伤患者的首选治疗方法。受伤主动脉的具体特征也决定了修复所需的血管内装置类型。本文介绍了一名钝性创伤患者和一名穿透性创伤患者的病例回顾，以展示临床参数、成像选择以及支架移植物选择和放置的细节，随后对文献进行了综述。
