Astolfi D, di Carlo D, di Eusanio G, Marcelletti C
Thorax. 1976 Dec;31(6):753-6. doi: 10.1136/thx.31.6.753.
Penetrating injuries of the thoracic aorta are usually rapidly lethal. Few patients survive for long enough to undergo surgical treatment. When penetrating injuries of the thoracic aorta are complicated by arteriovenous fistula a correct preoperative diagnosis is important for adequate planning of the surgical repair, and so selective angiography is essential. The best approach is through a median sternotomy with the use of total cardiopulmonary bypass with or without deep hypothermia and circulatory arrest. Fistulae between aorta and innominate vein invariably lead to congestive cardiac failure. A review of the literature suggests that signs of cardiac failure rarely appear early. Congestive failure developed within 30 days of the initial trauma in only two of the 12 reported cases. In our case, the early onset of cardac failure refractory to therapy and the appearance of an expanding pulsatile mass at the base of the neck, threatening rupture, necessitated emergency surgical treatment.
胸主动脉穿透伤通常会迅速致命。很少有患者能存活足够长的时间来接受手术治疗。当胸主动脉穿透伤并发动静脉瘘时，正确的术前诊断对于手术修复的充分规划很重要，因此选择性血管造影必不可少。最佳方法是通过正中胸骨切开术，使用或不使用深低温和循环停止的全心肺转流。主动脉与无名静脉之间的瘘总是导致充血性心力衰竭。文献回顾表明，心力衰竭的症状很少早期出现。在12例报告病例中，只有2例在初次创伤后30天内出现充血性心力衰竭。在我们的病例中，心力衰竭早期发作且对治疗无效，同时颈部根部出现一个不断扩大的搏动性肿块，有破裂风险，因此需要进行紧急手术治疗。
