Division of Vascular Surgery, Stanford University, Stanford, CA.
Division of Vascular Surgery, Stanford University, Stanford, CA.
Ann Vasc Surg. 2021 Jan;70:101-108. doi: 10.1016/j.avsg.2020.06.049. Epub 2020 Jun 27.
Thoracic endovascular aneurysm repair (TEVAR) has become the current standard of care for emergent treatment of traumatic blunt thoracic aortic injuries (BTAI). Although aortic dilation (AD) of the infrarenal neck after EVAR for aortic aneurysms has been studied, changes in aortic diameter after TEVAR for BTAI is not well understood. This study aims to characterize changes in thoracic aortic diameter after stent-graft placement in the setting of nonaneurysmal traumatic aortic injury.
A single-center, retrospective review was performed involving patients presenting with BTAI treated with TEVAR. Only patients with at least 12 months follow-up were included. Aortic diameter, defined as the outer-to-outer diameter on 3D center-line imaging, was measured at six locations along the proximal and mid thoracic aorta. The first postoperative CT (≤1 month) served as a baseline from which interval measurements were compared.
Twenty patients with BTAI treated from 2011 to 2017 had adequate imaging available for review and were included in this study cohort. Median follow-up time was 46.8 (12-80, range) months. At the latest follow-up, AD occurred at all measured locations within the endograft, starting from the proximal graft edge (0.62 ± 0.69 mm, P = 0.027) to the distal graft edge (1.21 ± 1.28 mm, P = 0.003). AD was most pronounced in the distal graft segment 2 cm proximal to the distal graft edge, with a mean AD of 1.32 ± 1.59 mm (+5.3%, P < 0.001). At this location, AD was found to increase in a linear manner with an estimated rate of 0.67 ± 0.20 mm/year (P = 0.006). The native aorta proximal and distal to the endograft was not found to significantly dilate during follow-up (P = 0.280-0.897). Seventy percent of the patients were found to have AD >5%. The amount of AD was not found to be associated with either graft oversizing (P = 0.151) or age (P = 0.340). There were no cases of graft migration, erosion, or endoleak.
AD is a common benign finding after TEVAR for BTAI. AD is most pronounced at the near the distal end of the stent graft. In late-term follow-up, there are no known associated complications related to AD.
胸主动脉腔内修复术（TEVAR）已成为治疗外伤性钝性胸主动脉损伤（BTAI）的当前标准治疗方法。尽管已经研究了腹主动脉瘤腔内修复术后肾下主动脉颈的扩张（AD），但 BTAI 后主动脉直径的变化尚不清楚。本研究旨在描述非动脉瘤性外伤性主动脉损伤患者支架置入后胸主动脉直径的变化。
对接受 TEVAR 治疗的 BTAI 患者进行了单中心回顾性研究。仅纳入至少随访 12 个月的患者。主动脉直径定义为 3D 中心线成像上的外-外直径，在近端和中段胸主动脉的六个部位测量。术后首次 CT（≤1 个月）作为基线，与间隔测量值进行比较。
2011 年至 2017 年期间，20 名 BTAI 患者的影像学资料足够，纳入本研究队列。中位随访时间为 46.8（12-80，范围）个月。在最新的随访中，在支架内的所有测量部位均发生 AD，从近端移植物边缘开始（0.62±0.69mm，P=0.027）到远端移植物边缘（1.21±1.28mm，P=0.003）。AD 在远端移植物段最明显，距远端移植物边缘近端 2cm 处的平均 AD 为 1.32±1.59mm（+5.3%，P<0.001）。在该位置，AD 呈线性增加，估计速度为 0.67±0.20mm/年（P=0.006）。在支架内和支架外的近端和远端主动脉在随访期间未发现明显扩张（P=0.280-0.897）。70%的患者存在 AD>5%。AD 量与移植物过度扩张（P=0.151）或年龄（P=0.340）无关。无移植物迁移、侵蚀或内漏病例。
AD 是 BTAI 后 TEVAR 的常见良性发现。AD 在支架移植物的远端附近最为明显。在晚期随访中，与 AD 相关的已知并发症并不存在。
