García Reyes Marvin Ernesto, Gonçalves Martins Gabriela, Fernández Valenzuela Valentín, Domínguez González José Manuel, Maeso Lebrun Jordi, Bellmunt Montoya Sergi
Department of Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Department of Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Ann Vasc Surg. 2018 Jul;50:140-147. doi: 10.1016/j.avsg.2018.02.001. Epub 2018 Feb 15.
The acute aortic arch angle and narrow aortic diameter in young patients may lead to bird-beak configuration and excessive oversizing of the stent graft in thoracic endovascular aortic repair (TEVAR) for blunt traumatic thoracic aortic injury (BTTAI). Little is known about the association of these factors and complications in long-term follow-up. We evaluated the long-term outcomes in terms of complications, reinterventions, and survival, focusing on the effects of bird-beak configuration and oversizing.
This prospective cohort study included patients who underwent TEVAR for BTTAI in our department between October 1999 and January 2015. The main outcomes were migration, collapse, intragraft mural thrombus, reintervention, and survival and their association with oversizing and bird-beak configuration.
Thirty-four patients were included. Median age was 36 years, and 21% were women. Mean graft oversizing was 19% (range: 8-27%) at the proximal end and 27% (range:, -20% to 50%) at the distal end. Mean follow-up was 98 months (12-198 months). Seven patients presented intragraft mural thrombus, one of whom developed an occlusive parietal thrombosis 1 year after the procedure. Four patients (9%) required reintervention: postoperative revascularization of the left subclavian artery in 2 cases and aortic reinterventions in 2 others. No migration or mortality was seen during follow-up. Bird-beak configuration was seen in 65%: the mean protrusion extension was 16 mm (standard deviation [SD]: 7.4 mm) and the mean angle was 51° (SD: 16°). The association between the complications and bird beak was not statistically significant. Patients with complications had significantly higher proximal end oversizing (23%) than the group with no complications (17%) (P = 0.0007).
TEVAR for BTTAI shows good results in the long-term follow-up. Complications in our series seemed related to proximal end oversizing. Thoracic stent grafts with a smaller diameter should be available in all trauma centers to avoid excessive oversizing.
年轻患者急性主动脉弓角度和主动脉直径狭窄可能导致鸟嘴样形态，并在钝性创伤性胸主动脉损伤（BTTAI）的胸主动脉腔内修复术（TEVAR）中使支架移植物过度超径。关于这些因素与长期随访并发症之间的关联知之甚少。我们评估了并发症、再次干预和生存方面的长期结果，重点关注鸟嘴样形态和超径的影响。
这项前瞻性队列研究纳入了1999年10月至2015年1月期间在我科接受BTTAI的TEVAR治疗的患者。主要结局为移位、塌陷、移植物内附壁血栓、再次干预和生存及其与超径和鸟嘴样形态的关联。
纳入34例患者。中位年龄为36岁，21%为女性。近端平均移植物超径为19%（范围：8%-27%），远端为27%（范围：-20%至50%）。平均随访时间为98个月（12-198个月）。7例患者出现移植物内附壁血栓，其中1例在术后1年发生闭塞性壁内血栓形成。4例患者（9%）需要再次干预：2例为术后左锁骨下动脉血运重建，另外2例为主动脉再次干预。随访期间未见移位或死亡。65%可见鸟嘴样形态：平均突出延伸为16mm（标准差[SD]：7.4mm），平均角度为51°（SD：16°）。并发症与鸟嘴之间的关联无统计学意义。有并发症的患者近端超径（23%）显著高于无并发症组（17%）（P = 0.0007）。
BTTAI的TEVAR在长期随访中显示出良好结果。我们系列中的并发症似乎与近端超径有关。所有创伤中心都应备有直径较小的胸段支架移植物，以避免过度超径。
