Kim Joung Taek, Kim Young Sam, Yoon Yong Han, Shin Helen Ki, Park Keun Myoung, Baek Wan Ki
Departments of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Republic of Korea.
Departments of Anesthesiology, Inha University Hospital, Incheon, Republic of Korea.
Thorac Cardiovasc Surg. 2018 Apr;66(3):248-254. doi: 10.1055/s-0038-1626703. Epub 2018 Feb 2.
The recently developed thoracic endovascular repair (TEVAR) technique seems to offer a good alternative for treating acute traumatic transection of the thoracic aorta (TTA). We reviewed our experience of TEVAR in cases of acute traumatic transection and analyzed the subsequent remodeling changes.
The medical records of 17 patients who underwent TEVAR for TTA were reviewed. The trauma mechanisms, anatomical characteristics of the transected aortas, technical details of TEVAR, and postprocedural results were reviewed.
The overall mean injury severity score was 53 ± 12. On three-dimensional computed tomography (CT), the mean distance of transection from the left subclavian artery was 14 ± 9 (0-31) mm. Fifteen patients presented an aortic pseudoaneurysm and two patients had impending rupture. TEVAR was performed emergently under general endotracheal induction. Technical success was achieved and complete pseudoaneurysm sealing was confirmed with aortography in all 17 patients. Two patients (12%) died of hypovolemic shock and hyperkalemia; however, no late death or stent-related complication occurred during the 45 ± 32 (6-102) months of follow-up. During a mean CT follow-up of 35 months, the mean aortic diameter increased by 2 (0-5) mm and pseudoaneurysm lesions completely disappeared in all patients.
TEVAR resulted in good early survival in patients with TTA. No late or stent graft-related event was encountered up to a maximum of 9 years after surgery. We recommend that patients with grade III or higher TTA should undergo emergency surgery. Moreover, we consider that long-term follow-up and blood pressure management are essential when the proximal aortic diameter is found to increase slightly after TEVAR on follow-up CT.
最近开发的胸主动脉腔内修复术（TEVAR）似乎为治疗急性创伤性胸主动脉横断伤（TTA）提供了一种很好的替代方法。我们回顾了我们在急性创伤性横断伤病例中应用TEVAR的经验，并分析了随后的重塑变化。
回顾了17例因TTA接受TEVAR治疗的患者的病历。回顾了创伤机制、横断主动脉的解剖特征、TEVAR的技术细节和术后结果。
总体平均损伤严重程度评分为53±12。在三维计算机断层扫描（CT）上，横断处距左锁骨下动脉的平均距离为14±9（0-31）mm。15例患者出现主动脉假性动脉瘤，2例患者有即将破裂的情况。在全身气管内诱导下紧急进行TEVAR。17例患者均获得技术成功，主动脉造影证实假性动脉瘤完全封闭。2例患者（12%）死于低血容量性休克和高钾血症；然而，在45±32（6-102）个月的随访期间未发生晚期死亡或支架相关并发症。在平均35个月的CT随访期间，主动脉平均直径增加了2（0-5）mm，所有患者的假性动脉瘤病变完全消失。
TEVAR使TTA患者获得了良好的早期生存率。术后长达9年未发生晚期或支架移植物相关事件。我们建议III级或更高等级的TTA患者应接受急诊手术。此外，我们认为，当随访CT发现TEVAR后近端主动脉直径略有增加时，长期随访和血压管理至关重要。
