Alhaizaey Abdullah, Aljabri Badr, Alghamdi Musaad, AlAhmari Ali, Abulyazied Ahmed, Asiry Mohammed, Al-Omran Mohammed
Division of Vascular Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia.
Aorta (Stamford). 2019 Oct;7(5):129-136. doi: 10.1055/s-0039-3401022. Epub 2020 Feb 4.
Endovascular stent grafting has emerged as an option to treat traumatic aorta injuries with reported significantly low mortality and morbidity. Stent collapse is one of the complications that can occur in this type of treatment. The aim of this article is to analyze the expected cause of stent collapse and to draw attention to the importance of the surveillance follow-up, as this phenomenon may occur late postdeployment.
A retrospectively collected dataset from the two highest volume trauma centers in Saudi Arabia was analyzed between April 2007 and October 2012. A total of 66 patients received stent grafts for traumatic aortic injury and were included in the study. We apply Ishimaru's anatomical aortic arch zones and Benjamin's aortic injury grading systems. There were 35 patients with aortic injury at zone 2, 26 patients in zone 3, and 5 patients in zone 4. About 96% (63) of the injuries were grades 2 and 3, including large intimal flap or aortic wall pseudoaneurysm with change in wall contour. The technical success rate, as defined by complete exclusion of lesions without leaks, stroke, arm ischemia or stent-related complications, was 90%.
Proximal stent collapse occurred in 4.5% of patients (3 of 66 inserted stents) during follow-up of 4 to 8 years (mean, 6 years). Patients with stent collapse tended to have an acute aortic arch angle with long-intraluminal stent lip, when compared with patients with noncollapsed stents. Intraluminal lip protrusion more than 10-mm increased collapse ( < 0.001). Stent-grafts sizes larger than 28 mm also demonstrated a higher collapse rate ( < 0.001).
The risk of stent collapse appears related to poor apposition of the stent due to severe aortic arch angulation in young patients and to large stent sizes (>28 mm). Such age groups may have more anatomical and aortic size changes during the growth. Clinical and radiological surveillance is essential in follow-up after stent-graft treatment for traumatic aortic injury.
血管内支架植入术已成为治疗创伤性主动脉损伤的一种选择，据报道其死亡率和发病率显著降低。支架塌陷是这类治疗中可能出现的并发症之一。本文旨在分析支架塌陷的预期原因，并提醒注意监测随访的重要性，因为这种现象可能在术后晚期发生。
对2007年4月至2012年10月期间从沙特阿拉伯两个最大的创伤中心回顾性收集的数据集进行分析。共有66例因创伤性主动脉损伤接受支架植入的患者纳入本研究。我们应用了石丸的主动脉弓解剖分区和本杰明的主动脉损伤分级系统。2区有35例主动脉损伤患者，3区有26例，4区有5例。约96%（63例）的损伤为2级和3级，包括大的内膜瓣或主动脉壁假性动脉瘤伴壁轮廓改变。以完全排除病变且无渗漏、中风、手臂缺血或支架相关并发症来定义的技术成功率为90%。
在4至8年（平均6年）的随访期间，4.5%的患者（66个植入支架中的3个）发生了近端支架塌陷。与未发生塌陷的支架患者相比，发生支架塌陷患者的主动脉弓角往往较锐且腔内支架唇较长。腔内唇突出超过10毫米会增加塌陷风险（P<0.001）。直径大于28毫米的支架移植物也显示出较高的塌陷率（P<0.001）。
支架塌陷风险似乎与年轻患者严重的主动脉弓成角导致支架贴合不良以及支架尺寸较大（>28毫米）有关。这类年龄组在生长过程中可能有更多的解剖结构和主动脉尺寸变化。对于创伤性主动脉损伤的支架移植物治疗后，临床和影像学监测在随访中至关重要。
