I 级- II 级钝性创伤性主动脉损伤的自然病史。
Natural history of grade I-II blunt traumatic aortic injury.
机构信息
Department of Surgery Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn.
出版信息
J Vasc Surg. 2014 Feb;59(2):334-41. doi: 10.1016/j.jvs.2013.09.007. Epub 2013 Dec 15.
BACKGROUND
Endovascular aortic repair has revolutionized the management of traumatic blunt aortic injury (BAI). However, debate continues about the extent of injury requiring endovascular repair, particularly with regard to minimal aortic injury. Therefore, we conducted a retrospective observational analysis of our experience with these patients.
METHODS
We retrospectively reviewed all BAI presenting to an academic level I trauma center over a 10-year period (2000-2010). Images were reviewed by a radiologist and graded according to Society for Vascular Surgery guidelines (grade I-IV). Demographics, injury severity, and outcomes were recorded.
RESULTS
We identified 204 patients with BAI of the thoracic or abdominal aorta. Of these, 155 were deemed operative injuries at presentation, had grade III-IV injuries or aortic dissection, and were excluded from this analysis. The remaining 49 patients had 50 grade I-II injuries. We managed 46 grade I injuries (intimal tear or flap, 95%), and four grade II injuries (intramural hematoma, 5%) nonoperatively. Of these, 41 patients had follow-up imaging at a mean of 86 days postinjury and constitute our study cohort. Mean age was 41 years, and mean length of stay was 14 days. The majority (48 of 50, 96%) were thoracic aortic injuries and the remaining two (4%) were abdominal. On follow-up imaging, 23 of 43 (55%) had complete resolution of injury, 17 (40%) had no change in aortic injury, and two (5%) had progression of injury. Of the two patients with progression, one progressed from grade I to grade II and the other progressed from grade I to grade III (pseudoaneurysm). Mean time to progression was 16 days. Neither of the patients with injury progression required operative intervention or died during follow-up.
CONCLUSIONS
Injury progression in grade I-II BAI is rare (~5%) and did not cause death in our study cohort. Given that progression to grade III injury is possible, follow-up with repeat aortic imaging is reasonable.
背景
血管内主动脉修复术彻底改变了外伤性钝性主动脉损伤（BAI）的治疗方法。然而，关于需要血管内修复的损伤程度仍存在争议，特别是对于轻微的主动脉损伤。因此，我们对这些患者的经验进行了回顾性观察分析。
方法
我们回顾性分析了 10 年来（2000-2010 年）在一家学术水平 I 级创伤中心就诊的所有 BAI 患者。由放射科医生对图像进行评估，并根据血管外科学会指南进行分级（I-IV 级）。记录患者的人口统计学、损伤严重程度和结局。
结果
我们共确定了 204 例胸或腹主动脉 BAI 患者。其中，155 例患者在就诊时被认为是手术性损伤，且存在 III-IV 级损伤或主动脉夹层，因此被排除在本分析之外。其余 49 例患者的 50 处损伤为 I-II 级。我们对 46 处 I 级损伤（内膜撕裂或瓣叶，95%）和 4 处 II 级损伤（壁内血肿，5%）进行了非手术治疗。其中，41 例患者在损伤后平均 86 天进行了随访影像学检查，构成了我们的研究队列。患者的平均年龄为 41 岁，平均住院时间为 14 天。大多数（50 例中的 48 例，96%）为胸主动脉损伤，其余 2 例（4%）为腹主动脉损伤。在随访影像学检查中，43 例中的 23 例（55%）的损伤完全缓解，17 例（40%）的主动脉损伤无变化，2 例（5%）的损伤进展。进展的 2 例患者中，1 例从 I 级进展为 II 级，另 1 例从 I 级进展为 III 级（假性动脉瘤）。进展的平均时间为 16 天。在随访期间，没有进展的患者需要手术干预或死亡。
结论
I-II 级 BAI 中的损伤进展较为罕见（约 5%），且在我们的研究队列中并未导致死亡。鉴于可能进展为 III 级损伤，进行重复主动脉成像随访是合理的。
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