Tang Shoujun, Tang Shengjie, Yu Li, Zhang Yongheng, Zhou Haining
Cardiovascular Center, Suining Central Hospital, No.127, West Desheng Road, Chuanshan District, Suining, 629000, Sichuan, China.
Department of ECG, Suining Central Hospital, Suining, 629000, China.
J Cardiothorac Surg. 2019 Apr 8;14(1):68. doi: 10.1186/s13019-019-0896-9.
Traumatic aortic arch rupture with pseudoaneurysm is a rare high fatal injury. Thoracic endovascular aortic repair(TEVAR) is widely used in the treatment of aortic diseases. However a unified traumatic aortic injury risk stratification tool still lacks. The patients' disease assessment and operation method still rely on the doctors' subjective anticipation of disease and surgical results.
A 31-year-old male presented with chest pain and hoarseness of recent onset. Imageological examination showed aortic rupture with mediastinal pseudoaneurysm in Zone 1. Debranching + TEVAR hybrid operation was considered: Using artificial blood vessels rebuild the arch branches, the covered stent was placed in aortic arch for endovascular repair via femoral artery. The follow-up was good in postoperative 7d, 1 year and > 2 years.
The traumatic aortic arch rupture with pseudoaneurysm treated by Debranching+TEVAR hybrid operation is feasible. The short-term and medium-term follow-up results are satisfactory. For traumatic aortic arch injury, hybrid operation is recommended to reduce the risk of cardiopulmonary bypass and deep hypothermia circulatory arrest under no open operation conditions or emergency situation.
创伤性主动脉弓破裂伴假性动脉瘤是一种罕见的高致命性损伤。胸主动脉腔内修复术（TEVAR）广泛应用于主动脉疾病的治疗。然而，目前仍缺乏统一的创伤性主动脉损伤风险分层工具。患者的病情评估和手术方式仍依赖于医生对疾病和手术结果的主观预判。
一名31岁男性，近期出现胸痛和声音嘶哑。影像学检查显示1区主动脉破裂伴纵隔假性动脉瘤。考虑采用去分支+TEVAR杂交手术：使用人工血管重建弓部分支，经股动脉将覆膜支架置入主动脉弓进行腔内修复。术后7天、1年及>2年随访情况良好。
去分支+TEVAR杂交手术治疗创伤性主动脉弓破裂伴假性动脉瘤是可行的。短期和中期随访结果满意。对于创伤性主动脉弓损伤，建议采用杂交手术，以在非开放手术条件或紧急情况下降低体外循环和深低温停循环的风险。
