Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA.
J Vasc Surg. 2013 Aug;58(2):380-5. doi: 10.1016/j.jvs.2013.01.045. Epub 2013 Jun 10.
This study reviewed the natural history of blunt thoracic aortic trauma (BTAT) over a 14-year period at our level 1 trauma center and compared open vs endovascular treatment.
All patients with BTAT presenting to a level 1 trauma center from 1998 to 2011 were included in a retrospective analysis. Multiple data points and short-term and midterm outcomes were ascertained through a retrospective record review.
We identified 129 patients with BTAT. Of these, 32 (25%) were dead on arrival, 38 (29%) underwent a resuscitative thoracotomy and died, 33 (26%) underwent open repair, 14 (11%) underwent endovascular repair, 9 (7%) underwent simultaneous procedures, and 3 (2%) were managed nonoperatively. Mean Injury Severity Scores and Revised Trauma Scores were similar (P = .484, P = .551) between the open repair group (n = 36) and the endovascular repair group (n = 14). In the open repair group, there were 14 deaths (42%) ≤ 30 days of injury, 3 strokes (9%), 2 patients (6%) with paralysis, 2 myocardial infarctions (MIs; 6%), and 3 patients (9%) who required hemodialysis. In the endovascular group, there was 1 death (7%) ≤ 30 days of injury, 1 (7%) stroke, and 1 (7%) stent collapse. No paralysis, MI, or renal failure requiring hemodialysis was noted in the endovascular group. The average length of stay was 15 days for patients treated with endovascular repair vs 24 days for those treated with open repair (P = .003).
The incidence of BTAT is low but the mortality associated with it is significant. During the 14-year period studied, there was a clear change in management preference from open repair to endovascular repair at our level 1 trauma center. Outcomes, including stroke, MI, renal failure, paralysis, length of stay, and death, appear to be reduced in the endovascular group.
本研究回顾了 14 年来我们的 1 级创伤中心的钝性胸主动脉创伤（BTAT）的自然病史，并比较了开放治疗与血管内治疗。
将 1998 年至 2011 年期间在 1 级创伤中心就诊的所有 BTAT 患者纳入回顾性分析。通过回顾性记录回顾确定了多个数据点以及短期和中期结果。
我们确定了 129 例 BTAT 患者。其中，32 例（25％）在到达时死亡，38 例（29％）进行了抢救性开胸手术并死亡，33 例（26％）进行了开放修复，14 例（11％）进行了血管内修复，9 例（7％）进行了同时进行的手术，3 例（2％）未进行手术治疗。开放修复组（n=36）和血管内修复组（n=14）的损伤严重程度评分和修订后的创伤评分相似（P=0.484，P=0.551）。在开放修复组中，有 14 例（42％）在伤后 30 天内死亡，3 例（9％）发生中风，2 例（6％）发生瘫痪，2 例（6％）发生心肌梗死（MI），3 例（9％）需要血液透析。在血管内组中，有 1 例（7％）在伤后 30 天内死亡，1 例（7％）发生中风，1 例（7％）支架塌陷。血管内组无瘫痪、MI 或需要血液透析的肾衰竭。血管内修复治疗患者的平均住院时间为 15 天，而开放修复治疗患者的平均住院时间为 24 天（P=0.003）。
BTAT 的发病率虽低，但与之相关的死亡率却很高。在研究的 14 年期间，我们的 1 级创伤中心的治疗方法从开放修复明显转变为血管内修复。血管内组的结局（包括中风、MI、肾衰竭、瘫痪、住院时间和死亡）似乎有所改善。
