Ben Hammamia M, Ben Mrad M, Ziadi J, Derbel B, Miri R, Ben Abdelaziz E, Daoud Z, Krarti N, Koubaa M A, Tarzi M, Khadhar Y, Lagha A, Ghedira F, Ben Omrane S, Kalfat T, Bounawes I, Denguir R
Cardiovascular department La Rabta, faculty of medicine of Tunis, university of Tunis El Manar, Tunis, Tunisia.
Cardiovascular department La Rabta, faculty of medicine of Tunis, university of Tunis El Manar, Tunis, Tunisia.
J Med Vasc. 2020 Sep;45(5):254-259. doi: 10.1016/j.jdmv.2020.06.007. Epub 2020 Jul 9.
Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture.
This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture.
Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14-66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18-36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5-96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported.
TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.
创伤性主动脉峡部破裂的传统开放修复术死亡率和发病率显著较高。胸主动脉腔内修复术（TEVAR）目前经常被采用，因为它是一种比手术侵入性更小的治疗方法。本研究的目的是评估TEVAR治疗创伤性主动脉峡部破裂的短期和中期结果。
这是一项在2010年至2018年期间进行的回顾性研究，纳入了因创伤性主动脉峡部破裂接受TEVAR治疗的患者。
连续纳入36例患者。所有患者在突然减速后均遭受了剧烈的钝性胸部创伤并伴有其他损伤。损伤严重程度评分（ISS）为40（14 - 66）。所有患者入院时血流动力学稳定。我们植入的胸主动脉支架移植物平均直径为26mm（18 - 36）。手术成功率为100%。我们报告了1例术中并发症，即移植物远端移位，通过植入主动脉延长移植物进行处理。术后第一天，1例患者出现急性下肢缺血，可能是由于手术造成的股动脉入路问题，采用Fogarty导管取栓治疗，效果满意。平均随访时间为40.41个月（6.5 - 96）。1个月及随访期间死亡率和截瘫率均为0%。我们报告了1例在6个月时发生的移植物扭结病例。未报告内漏及再次干预病例。
TEVAR是治疗亚急性创伤性胸主动脉损伤的一种安全可靠的方法。
