血管腔内钝性胸主动脉损伤修复的术后并发症
Postoperative complications of endovascular blunt thoracic aortic injury repair.
作者信息
Abdou Hossam, Elansary Noha N, Darko Louisa, DuBose Joseph J, Scalea Thomas M, Morrison Jonathan J, Kundi Rishi
机构信息
Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
出版信息
Trauma Surg Acute Care Open. 2021 Jul 15;6(1):e000678. doi: 10.1136/tsaco-2021-000678. eCollection 2021.
BACKGROUND
Thoracic endovascular aortic repair (TEVAR) has become the standard of care for thoracic aortic aneurysms and increasingly for blunt thoracic aortic injury (BTAI). Postoperative complications, including spinal cord ischemia and paraplegia, have been shown to be less common with elective TEVAR than with open thoracic or thoracoabdominal repair. Although small cohort studies exist, the postoperative complications of endovascular repair of traumatic aortic injury have not been described through large data set analysis.
METHODS
A retrospective cohort analysis was performed of the American College of Surgeons Trauma Quality Improvement Program registry spanning from 2007 to 2017. All patients with BTAI who underwent TEVAR, as indicated by the Abbreviated Injury Scale or the International Classification of Diseases (ICD-9 or ICD-10), were included. Categorical data were presented as proportions and continuous data as mean and SD. OR was calculated for each postoperative complication.
RESULTS
2990 patients were identified as having undergone TEVAR for BTAI. The postoperative incidence of stroke was 2.8% (83), and 4.7% (140) of patients suffered acute kidney injury or renal failure. The incidence of spinal cord ischemia was 1.9% (58), whereas 0.2% (7) of patients suffered complete paraplegia. Renal events and stroke were found to occur significantly more frequently in those undergoing TEVAR (OR 1.758, 1.449-2.134 and OR 2.489, 1.917-3.232, respectively). Notably, there was no difference between TEVAR and non-operative BTAI incidences of spinal cord ischemia or paraplegia (OR 1.061, 0.799-1.409 and OR 1.698, 0.728-3.961, respectively).
DISCUSSION
Postoperative intensive care unit care of patients after BTAI has historically focused on awareness of spinal cord ischemia. Our analysis suggests that after endovascular repair of blunt aortic trauma, care should involve vigilance primarily against postoperative cerebrovascular and renal events. Further study is warranted to develop guidelines for the intensivist managing patients after TEVAR for BTAI.
LEVEL OF EVIDENCE
Level III.
背景
胸主动脉腔内修复术（TEVAR）已成为治疗胸主动脉瘤的标准方法，并且越来越多地用于治疗钝性胸主动脉损伤（BTAI）。已表明，与开放性胸段或胸腹联合修复相比，择期TEVAR术后并发症（包括脊髓缺血和截瘫）的发生率较低。尽管存在一些小型队列研究，但尚未通过大数据集分析描述创伤性主动脉损伤血管内修复术后的并发症。
方法
对美国外科医师学会创伤质量改进计划登记处2007年至2017年的数据进行回顾性队列分析。纳入所有根据简明损伤量表或国际疾病分类（ICD-9或ICD-10）接受TEVAR治疗的BTAI患者。分类数据以比例表示，连续数据以均值和标准差表示。计算每种术后并发症的比值比（OR）。
结果
确定2990例患者接受了TEVAR治疗BTAI。术后中风发生率为2.8%（83例），4.7%（140例）的患者发生急性肾损伤或肾衰竭。脊髓缺血发生率为1.9%（58例），而0.2%（7例）的患者发生完全性截瘫。发现接受TEVAR治疗的患者发生肾脏事件和中风的频率明显更高（OR分别为1.758，1.449 - 2.134和OR 2.489，1.917 - 3.232）。值得注意的是，TEVAR与非手术治疗BTAI的脊髓缺血或截瘫发生率之间没有差异（OR分别为1.061，0.799 - 1.409和OR 1.698，0.728 - 3.961）。
讨论
历史上，BTAI患者术后重症监护病房护理主要关注脊髓缺血。我们的分析表明，钝性主动脉创伤血管内修复术后，护理应主要警惕术后脑血管和肾脏事件。有必要进行进一步研究，以制定针对接受TEVAR治疗BTAI患者的重症监护医生的指南。
证据级别
三级。
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