From the Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, Texas.
J Trauma Acute Care Surg. 2014 Feb;76(2):510-6. doi: 10.1097/TA.0b013e3182aafe8c.
Traumatic aortic injury (TAI) remains a leading cause of death after blunt force. Thoracic endovascular aortic repair (TEVAR) has been widely adopted as an alternative to open repair for the treatment of TAI. Although significant short-term benefits have been demonstrated for patients undergoing TEVAR, longer-term follow-up data are lacking.
Trauma registry data were analyzed. Follow-up data were gathered from a combination of medical records, imaging, telephone interviews, and Social Security Death Index. Primary outcomes were in-hospital mortality, stroke, and paraplegia. Secondary outcomes included device-related adverse events (rupture, migration, or endoleak), secondary procedures, open conversion, and all-cause mortality.
Between September 2005 and July 2012, 82 consecutive patients (57 males, mean [SD] age, 39.5 [20] years; mean [SD] Injury Severity Score [ISS], 34 [9.5]) underwent TEVAR for TAI. A total of 87 devices were implanted: TAG (n = 36), CTAG (n = 12) (WL Gore, Flagstaff, AZ); Talent (n = 29), Valiant (n = 5) (Medtronic, Santa Rosa, CA); TX2 (n = 2) (Cook, Bloomington, IN); and other (n = 3). Left subclavian artery coverage was required in 32 patients (39%). Technical success rate was 100%. Rates of in-hospital mortality, stroke, and paraplegia were 5.0%, 2.4%, and 0%, respectively.Median follow-up time was 2.3 years (range, 0-7 years). The availability of follow-up data was as follows: Social Security Death Index (100%), telephone interview (68%), clinic visit (61%), and imaging (82%). The incidence of device-related adverse events was 2.4%. There were four secondary procedures: two patients underwent a carotid-subclavian bypass, and two had an open conversion for device-related complications. Survival was 95% at 30 days, 88% at 1 year, 87% at 2 years, and 82% at 5 years.
At midterm follow-up, TEVAR is an effective and durable option for the treatment of TAI in properly selected patients. Device-related adverse events, secondary procedures, and open conversion are rare. Follow-up remains a challenge.
Therapeutic study, level V.
创伤性主动脉损伤（TAI）仍然是钝性外伤后的主要死亡原因。胸主动脉腔内修复术（TEVAR）已广泛应用于 TAI 的治疗，替代开放修复。尽管接受 TEVAR 的患者显示出显著的短期益处，但缺乏长期随访数据。
分析创伤登记数据。通过病历、影像学检查、电话访谈和社会保障死亡指数相结合来收集随访数据。主要结局是院内死亡率、卒中和截瘫。次要结局包括器械相关不良事件（破裂、移位或内漏）、二次手术、开放转换和全因死亡率。
2005 年 9 月至 2012 年 7 月，82 例连续患者（57 例男性，平均[标准差]年龄 39.5[20]岁；平均[标准差]损伤严重度评分[ISS] 34[9.5]）因 TAI 接受 TEVAR 治疗。共植入 87 个器械：TAG（n=36）、CTAG（n=12）（WL Gore，Flagstaff，AZ）；Talent（n=29）、Valiant（n=5）（美敦力，圣拉扎罗，CA）；TX2（n=2）（库克，布鲁明顿，IN）；以及其他（n=3）。32 例（39%）需要覆盖左锁骨下动脉。技术成功率为 100%。院内死亡率、卒中和截瘫的发生率分别为 5.0%、2.4%和 0%。中位随访时间为 2.3 年（0-7 年）。随访数据的获得情况如下：社会保障死亡指数（100%）、电话访谈（68%）、门诊就诊（61%）和影像学检查（82%）。器械相关不良事件的发生率为 2.4%。有 4 例二次手术：2 例患者行颈动脉-锁骨下旁路术，2 例因器械相关并发症行开放转换。30 天存活率为 95%，1 年存活率为 88%，2 年存活率为 87%，5 年存活率为 82%。
在中期随访中，TEVAR 是一种有效且持久的选择，适用于适当选择的 TAI 患者。器械相关不良事件、二次手术和开放转换很少见。随访仍然是一个挑战。
治疗研究，5 级。
