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胸主动脉腔内修复术(TEVAR)治疗Ⅲ级创伤性胸主动脉损伤

Thoracic Endovascular Aortic Repair (TEVAR) for Grade III Traumatic Thoracic Aortic Injury.

作者信息

Rojas Guevara Paola Andrea, Gallardo-Navarro Elias, Garnica León Luis Alberto, Vargas Mendez Gisela Margarita, Segura Marín Héctor, Pérez Damian Venancio

机构信息

Angiology, Vascular and Endovascular Surgery, Hospital Español, Mexico City, MEX.

General Surgery, Hospital Español, Mexico City, MEX.

出版信息

Cureus. 2025 Jun 20;17(6):e86454. doi: 10.7759/cureus.86454. eCollection 2025 Jun.

Abstract

The thoracic endovascular aortic repair (TEVAR) procedure has become a preferred option for managing traumatic lesions of the thoracic aorta due to its ability to intervene in a minimally invasive manner and reduce the risk of complications. This approach allows rapid patient stabilization by avoiding open surgery and facilitates the management of critical conditions, such as pseudoaneurysms of the descending aorta. Aortic contusion injury caused by trauma and deceleration is an important and serious cause of mortality related to trauma, since most of those who suffer it die at the site of the accident or in the first hours of hospital care. Hence, the clinical suspicion and the rapid approach during primary care when locating serious conditions, such as thoracic aortic injury, are of utmost importance for the survival of the affected patient. A 26-year-old woman who suffered a thoracic aortic injury due to automobile trauma was brought to the ED. She underwent TEVAR with endoprosthesis placement due to a diagnosis of pseudoaneurysm and dissection of the descending thoracic aorta (aortic isthmus). The endovascular repair was adequate. The follow-up was conducted with thoracic angiotomography, also known as a CT angiography of the chest, a medical imaging procedure that uses X-rays and a contrast dye to visualise the blood vessels in the chest, particularly the thoracic aorta, at the time of the procedure and 12 months postoperatively. The patient's clinical evolution was favourable, with the endovascular intervention proving to be an adequate option for both diagnostic and therapeutic emergency management.

摘要

胸主动脉腔内修复术(TEVAR)因其能够以微创方式进行干预并降低并发症风险,已成为治疗胸主动脉创伤性病变的首选方法。这种方法通过避免开胸手术实现患者的快速稳定,并有助于处理危急情况,如下降主动脉假性动脉瘤。创伤和减速导致的主动脉挫伤是创伤相关死亡的一个重要且严重的原因,因为大多数遭受这种损伤的人在事故现场或住院治疗的最初几个小时内死亡。因此,在初级护理中,当发现严重情况(如胸主动脉损伤)时,临床怀疑和快速处理对受影响患者的存活至关重要。一名因汽车创伤导致胸主动脉损伤的26岁女性被送往急诊室。由于诊断为降胸主动脉(主动脉峡部)假性动脉瘤和夹层,她接受了带覆膜支架植入的TEVAR手术。血管内修复效果良好。随访采用胸部血管造影断层扫描,也就是胸部CT血管造影,这是一种医学成像检查,在手术时和术后12个月使用X射线和造影剂来显示胸部血管,特别是胸主动脉。患者的临床进展良好,血管内干预被证明是诊断和治疗紧急情况的合适选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e041/12276816/3d61f16508a1/cureus-0017-00000086454-i01.jpg

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