Tigkiropoulos Konstantinos, Sigala Fragiska, Tsilimigras Diamantis I, Moris Demetrios, Filis Konstantinos, Melas Nikolaos, Karamanos Dimitrios, Kontogiannis Christos, Lazaridis Ioannis, Saratzis Nikolaos
1st Department of Surgery, Aristotle University Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
1st Department of Propaedeutic Surgery, Hippokration University Hospital, University of Athens Medical School, Athens, Greece.
Ann Vasc Surg. 2018 Jul;50:160-166.e1. doi: 10.1016/j.avsg.2018.01.100. Epub 2018 Mar 7.
Blunt thoracic aortic injury (BTAI) is the second most common cause of death in trauma patients. Nowadays, thoracic endovascular aortic repair (TEVAR) has become the treatment of choice because of lower rates of mortality, paraplegia, and stroke. However, concerns have been raised whether graft implantation is related to the development of hypertension in the postoperative period. The aim of this study was to report short- and long-term outcomes of patients undergoing TEVAR for BTAIs at a tertiary hospital and to investigate postimplant hypertension.
Between January 2005 and January 2016, 23 patients with blunt thoracic aortic trauma underwent TEVAR. Median age was 44 years (range, 18-73). Among them, 14 (60.9%) patients were diagnosed with aortic rupture, whereas 9 (39.1%) with pseudoaneurysm. Α single thoracic stent graft was deployed in 21 patients, and the rest 2 patients received 2 stent grafts.
Complete exclusion of the injury was feasible in all subjects (100% primary success). The left subclavian artery (SCA) was intentionally covered in 6 patients (26%). Intraoperative complications included one nonfatal stroke managed conservatively and one external iliac artery rupture treated with iliofemoral bypass. One patient (4.3%) died on the first postoperative day in the intensive care unit (ICU) because of hemorrhagic shock. The overall 30-day mortality and morbidity were 4.3% and 8.7%, respectively. New-onset postimplantation arterial hypertension was observed in 8 (34.8%) previously nonhypertensive patients. Younger age (P = 0.027) and SCA coverage (P = 0.01) were identified as potential risk factors for the development of postimplant hypertension, whereas the presence of concomitant injuries (P = 0.3) and intraoperative complications (P = 0.1) were not. After a median follow-up of 100 months (range, 18-120), 6 of them still remain on antihypertensive therapy, whereas the other 2 did not require permanent treatment.
TEVAR is a safe approach in the treatment of BTAI associated with low short- and long-term morbidity and mortality rates. Lower age and SCA coverage may contribute to the development of postimplant hypertension. Further larger cohort studies are warranted to elucidate the underlying mechanisms of postimplant hypertension.
钝性胸主动脉损伤（BTAI）是创伤患者死亡的第二大常见原因。如今，胸主动脉腔内修复术（TEVAR）因其较低的死亡率、截瘫和中风发生率，已成为首选治疗方法。然而，有人担心移植物植入是否与术后高血压的发生有关。本研究的目的是报告在一家三级医院接受TEVAR治疗BTAI患者的短期和长期结果，并调查植入后高血压情况。
2005年1月至2016年1月期间，23例钝性胸主动脉创伤患者接受了TEVAR治疗。中位年龄为44岁（范围18 - 73岁）。其中，14例（60.9%）患者被诊断为主动脉破裂，而9例（39.1%）为假性动脉瘤。21例患者植入了单个胸主动脉覆膜支架，其余2例患者植入了2个覆膜支架。
所有患者均成功实现损伤完全隔绝（初次成功率100%）。6例患者（26%）左锁骨下动脉（SCA）被有意覆盖。术中并发症包括1例经保守治疗的非致命性中风和1例经髂股旁路手术治疗的髂外动脉破裂。1例患者（4.3%）术后第1天在重症监护病房（ICU）因失血性休克死亡。30天总体死亡率和发病率分别为4.3%和8.7%。8例（34.8%）既往无高血压的患者出现了植入后新发动脉高血压。较年轻的年龄（P = 0.027）和SCA覆盖（P = 0.01）被确定为植入后高血压发生的潜在危险因素，而合并损伤的存在（P = 0.3）和术中并发症（P = 0.1）则不是。中位随访100个月（范围18 - 120个月）后，其中6例仍在接受抗高血压治疗，而另外2例不需要长期治疗。
TEVAR是治疗BTAI的一种安全方法，短期和长期发病率及死亡率均较低。较低的年龄和SCA覆盖可能导致植入后高血压的发生。需要进一步开展更大规模的队列研究以阐明植入后高血压的潜在机制。
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