Lee Soojin, Song Seunghwan, Kim Seon Hee, Kim Chang Won, Kwon Hoon, Ryu Dongman, Lee Na Hyeon, Kim Eunji
Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Biomedical Research Institute, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, Republic of Korea.
Department of Trauma and Surgical Critical Care, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Gen Thorac Cardiovasc Surg. 2025 Apr;73(4):209-217. doi: 10.1007/s11748-024-02054-6. Epub 2024 Jul 5.
We aimed to investigate the changes in aorta size, the factors affecting size changes in patients with acute blunt traumatic aortic injury and to evaluate the adequacy of the current 120% thoracic endovascular aortic repair graft oversizing policy.
This retrospective review study was conducted using the prospectively collected medical records of 45 patients (mean age: 53.5 years, male: 39 patients) with blunt traumatic aortic injury treated at a level 1 trauma center between 2012 and 2021. Aortic diameter was measured by computed tomography angiographic images at four different levels [ascending aorta (A), isthmus (B), descending thoracic aorta (C), and infrarenal aorta (D)] on arrival and follow-up (median time interval, 13 days). Associated factors including patient characteristics and hemodynamic parameters on arrival and follow-up were collected to determine their influence on changes in the aorta.
The mean diameter of all four aortic levels increased on follow-up computed tomography compared to initial computed tomography (A: + 11.77%, B: + 10.19%, C: + 7.71%, D: + 12.04%). Patient age and injury severity score influenced changes in the diameter of the ascending aorta (P < 0.05). Patient age and blunt traumatic aortic injury grade were significantly associated with changes in the infrarenal aortic diameter (P < 0.05). Three cases of type 1 endoleak were observed at follow-up but all were spontaneously resolved without further intervention at next computed tomography follow-up.
In patients with acute blunt traumatic aortic injury, aortic diameter is significantly smaller by about 10% under shock and is not considered a basis for oversizing the currently implemented 120% thoracic endovascular aortic repair graft sizing. However, in young patients under the age of 40, the change is significantly large and subsequent computed tomography follow-up is required.
我们旨在研究急性钝性创伤性主动脉损伤患者主动脉大小的变化、影响大小变化的因素，并评估当前120%胸段血管腔内主动脉修复移植物过大尺寸策略的合理性。
本回顾性研究使用了2012年至2021年期间在一级创伤中心接受治疗的45例钝性创伤性主动脉损伤患者（平均年龄：53.5岁，男性：39例）的前瞻性收集的医疗记录。通过计算机断层血管造影图像在入院时和随访时（中位时间间隔，13天）测量四个不同水平[升主动脉（A）、峡部（B）、胸降主动脉（C）和肾下腹主动脉（D）]的主动脉直径。收集包括患者特征和入院时及随访时的血流动力学参数等相关因素，以确定它们对主动脉变化的影响。
与初始计算机断层扫描相比，随访计算机断层扫描时所有四个主动脉水平的平均直径均增加（A：+11.77%，B：+10.19%，C：+7.71%，D：+12.04%）。患者年龄和损伤严重程度评分影响升主动脉直径的变化（P<0.05）。患者年龄和钝性创伤性主动脉损伤分级与肾下腹主动脉直径的变化显著相关（P<0.05）。随访时观察到3例I型内漏，但在下次计算机断层扫描随访时均自发消退，无需进一步干预。
在急性钝性创伤性主动脉损伤患者中，休克时主动脉直径明显小约10%，不作为当前实施的120%胸段血管腔内主动脉修复移植物过大尺寸的依据。然而，对于40岁以下的年轻患者，变化显著较大，需要后续计算机断层扫描随访。
