Spencer Stephen M, Safcsak Karen, Smith Chadwick P, Cheatham Michael L, Bhullar Indermeet S
From the Orlando Regional Medical Center (S.M.S., C.P.S., I.S.B., K.S.), Orlando, Florida; and Orlando Health Surgical Group (M.L.C.), Orlando Regional Medical Center, Orlando, Florida.
J Trauma Acute Care Surg. 2018 Jan;84(1):133-138. doi: 10.1097/TA.0000000000001630.
The Society of Vascular Surgery (SVS) guidelines currently suggest thoracic endovascular aortic repair (TEVAR) for grade II-IV and nonoperative management (NOM) for grade I blunt traumatic aortic injury (BTAI). However, there is increasing evidence that grade II may also be observed safely. The purpose of this study was to compare the outcome of TEVAR and NOM for grade I-IV BTAI and determine if grade II can be safely observed with NOM.
The records of patients with BTAI from 2004 to 2015 at a Level I trauma center were retrospectively reviewed. Patients were separated into two groups: TEVAR versus NOM. All BTAIs were graded according to the SVS guidelines. Minimal aortic injury (MAI) was defined as BTAI grade I and II. Failure of NOM was defined as aortic rupture after admission or progression on subsequent computed tomography (CT) imaging requiring TEVAR or open thoracotomy repair (OTR). Statistical analysis was performed using Mann-Whitney U and χ tests.
A total of 105 adult patients (≥16 years) with BTAI were identified over the 11-year period. Of these, 17 patients who died soon after arrival and 17 who underwent OTR were excluded. Of the remaining 71 patients, 30 had MAI (14 TEVAR vs. 16 NOM). There were no failures in either group. No patients with MAI in either group died from complications of aortic lesions. Follow-up CT imaging was performed on all MAI patients. Follow-up CT scans for all TEVAR patients showed stable stents with no leak. Follow-up CT in the NOM group showed progression in two patients neither required subsequent OTR or TEVAR.
Although the SVS guidelines suggest TEVAR for grade II-IV and NOM for grade I BTAI, NOM may be safely used in grade II BTAI.
Therapeutic study, level IV.
血管外科学会（SVS）指南目前建议对Ⅱ - Ⅳ级钝性创伤性主动脉损伤（BTAI）进行胸主动脉腔内修复术（TEVAR），对Ⅰ级进行非手术治疗（NOM）。然而，越来越多的证据表明Ⅱ级损伤也可安全观察。本研究的目的是比较Ⅰ - Ⅳ级BTAI的TEVAR和NOM治疗结果，并确定Ⅱ级损伤采用NOM是否安全。
回顾性分析2004年至2015年在一级创伤中心的BTAI患者记录。患者分为两组：TEVAR组与NOM组。所有BTAI均根据SVS指南分级。最小主动脉损伤（MAI）定义为BTAIⅠ级和Ⅱ级。NOM失败定义为入院后主动脉破裂或后续计算机断层扫描（CT）成像显示病情进展，需要进行TEVAR或开胸手术修复（OTR）。采用Mann-Whitney U检验和χ检验进行统计分析。
在11年期间共识别出105例成年（≥16岁）BTAI患者。其中，17例到达后不久死亡的患者和17例接受OTR的患者被排除。其余71例患者中，30例为MAI（14例TEVAR vs. 16例NOM）。两组均无失败病例。两组中MAI患者均无死于主动脉病变并发症。对所有MAI患者进行了随访CT成像。所有TEVAR患者的随访CT扫描显示支架稳定，无渗漏。NOM组的随访CT显示2例病情进展，但均无需后续OTR或TEVAR。
尽管SVS指南建议对Ⅱ - Ⅳ级BTAI采用TEVAR，对Ⅰ级采用NOM，但NOM可安全用于Ⅱ级BTAI。
治疗性研究，Ⅳ级。
