Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, Post-office 85500, 3508 GA, Utrecht, The Netherlands.
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):1961-1973. doi: 10.1007/s00068-020-01432-y. Epub 2020 Jul 6.
Treatment of blunt thoracic aortic injuries (BTAIs) has shifted from the open surgical approach to the use of thoracic endovascular aortic repair (TEVAR), of which early outcomes appear promising but controversy regarding long-term outcomes remains. The goal of this study was to determine the long-term TEVAR outcomes for BTAI, particularly radiographic outcomes, complications and health-related quality of life (HRQoL).
Retrospectively, all patients with BTAIs presented at a single level 1 trauma center between January 2008 and December 2018 were included. Radiographic and clinical outcomes were determined (early and long term). In addition, HRQoL scores using EuroQOL-5-Dimensions-3-Level (EQ-5D-3L) and Visual Analog Scale (EQ-VAS) questionnaires were assessed, and compared to an age-adjusted reference and trauma population.
Thirty-one BTAI patients met the inclusion criteria. Of these, 19/31 received TEVAR of which three died in hospital due to aorta-unrelated causes. In total, 10/31 patients died due to severe (associated) injuries before TEVAR could be attempted. The remaining 2/31 had BTAIs that did not require TEVAR. Stent graft implantation was successful in all 19 patients (100%). At a median radiographic follow-up of 3 years, no stent graft-related problems (endoleaks/fractures) were observed. However, one patient experienced acute stent graft occlusion approximately 2 years after TEVAR, successfully treated with open repair. Twelve patients required complete stent graft coverage of the left subclavian artery (LSCA) (63%), which did not result in ischemic complaints or re-interventions. Of fourteen surviving TEVAR patients, ten were available for questionnaire follow-up (follow-up rate 71%). At a median follow-up of 5.7 years, significant HRQoL impairment was found (p < 0.01).
This study shows good long(er)-term radiographic outcomes of TEVAR for BTAIs. LSCA coverage did not result in complications. Patients experienced HRQoL impairment and were unable to return to an age-adjusted level of daily-life functioning, presumably due to concomitant orthopedic and neurological injuries.
治疗钝性胸主动脉损伤（BTAI）已从开放手术方法转变为使用胸主动脉腔内修复术（TEVAR），其早期结果似乎很有前景，但长期结果仍存在争议。本研究的目的是确定 BTAI 的长期 TEVAR 结果，特别是影像学结果、并发症和健康相关生活质量（HRQoL）。
回顾性地，纳入了 2008 年 1 月至 2018 年 12 月期间在一家一级创伤中心就诊的所有 BTAI 患者。确定了影像学和临床结果（早期和长期）。此外，还使用欧洲五维健康量表 3 级（EQ-5D-3L）和视觉模拟量表（EQ-VAS）问卷评估了 HRQoL 评分，并与年龄调整参考值和创伤人群进行了比较。
31 名 BTAI 患者符合纳入标准。其中 19 例接受了 TEVAR 治疗，3 例因与主动脉无关的原因在住院期间死亡。共有 10 例/31 例患者因严重（相关）损伤在尝试 TEVAR 前死亡。其余 2 例/31 例患者的 BTAI 无需 TEVAR。19 例患者的支架植入均成功（100%）。在中位数为 3 年的影像学随访中，未观察到支架相关问题（内漏/骨折）。然而，1 例患者在 TEVAR 后约 2 年发生急性支架闭塞，成功接受了开放修复。12 例患者需要完全覆盖左锁骨下动脉（LSCA）的支架移植物（63%），未出现缺血症状或再干预。14 例存活的 TEVAR 患者中有 10 例可进行问卷调查随访（随访率 71%）。在中位数为 5.7 年的随访中，发现 HRQoL 显著受损（p<0.01）。
本研究表明，BTAI 的 TEVAR 具有良好的长期影像学结果。LSCA 覆盖并未导致并发症。患者经历了 HRQoL 受损，无法恢复到年龄调整后的日常生活功能水平，可能是由于同时存在的骨科和神经系统损伤所致。
