Department of Trauma and Surgical Critical Care, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Asian J Surg. 2022 Nov;45(11):2224-2230. doi: 10.1016/j.asjsur.2021.11.040. Epub 2021 Nov 23.
BACKGROUND/OBJECTIVE: Blunt traumatic aortic injury (BTAI) is rare and fatal. Treatment has evolved with advances in imaging and the emergence of thoracic endovascular aortic repair (TEVAR). This study reports a single-center, 5-year experience of TEVAR and open repair for BTAI.
Patients with BTAI treated at a level I trauma center from 2014 to 2019 were retrospectively reviewed with patient charts and successive computed tomography angiography images. Patients were grouped according to treatment modality: open repair, TEVAR, or medical management, chosen based on patients' characteristics and injury severity. Groups were compared in terms of preoperative demographics, injury characteristics, operative variables, short-term, and long-term outcomes.
Forty-two patients were included in the study: 16 (38%) underwent open repair, 17 (40.4%) underwent TEVAR, seven (16.6%) were managed medically, and two (4.7%) died during triage. The median age was 49 years (interquartile range [IQR], 38-57.5 years), and 92.5% were male; the median Injury Severity Score was 33 (IQR, 29-41). Overall mortality was 7.5%. The median hospital stay was 33 days (IQR, 19.5-58.5). Patients undergoing open repair were significantly younger (43 vs. 55 years; p = 0.002) and had a smaller aortic diameter (22.3 vs. 24.0 mm; p=<0.001) than those undergoing TEVAR. No BTAI-related late mortality or reintervention was observed during follow-ups.
This study demonstrated excellent outcomes with multidisciplinary team efforts and appropriate application of treatment modality. TEVAR is ideal for older or severely injured patients; open repair is an important alternative for young patients or patients with unsuitable aortic anatomy.
背景/目的：钝性创伤性主动脉损伤（BTAI）较为罕见且致命。随着影像学的进步和胸主动脉腔内修复术（TEVAR）的出现，其治疗方法也不断演变。本研究报告了一家一级创伤中心 5 年来应用 TEVAR 和开放修复治疗 BTAI 的经验。
回顾性分析 2014 年至 2019 年期间在一家一级创伤中心治疗的 BTAI 患者的病历和连续 CT 血管造影图像。根据治疗方式将患者分为开放修复组、TEVAR 组和药物治疗组，选择依据为患者的特征和损伤严重程度。比较各组患者的术前人口统计学、损伤特征、手术变量、短期和长期结果。
本研究共纳入 42 例患者：16 例（38%）接受开放修复，17 例（40.4%）接受 TEVAR，7 例（16.6%）接受药物治疗，2 例（4.7%）在分诊时死亡。患者的中位年龄为 49 岁（四分位距[IQR]，38-57.5 岁），92.5%为男性；损伤严重程度评分的中位数为 33（IQR，29-41）。总体死亡率为 7.5%。中位住院时间为 33 天（IQR，19.5-58.5）。与 TEVAR 组相比，行开放修复的患者明显更年轻（43 岁比 55 岁；p=0.002），主动脉直径更小（22.3 毫米比 24.0 毫米；p<0.001）。随访期间未观察到与 BTAI 相关的晚期死亡或再次干预。
本研究通过多学科团队的努力和适当的治疗方式应用，取得了良好的效果。TEVAR 适用于年龄较大或损伤严重的患者；对于年轻患者或主动脉解剖结构不适合的患者，开放修复是一种重要的替代方法。
