Hernández-Maldonado J J, Padberg F T, Teehan E, Neville R, DeFouw D, Durán W N, Hobson R W
Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103-6601.
J Trauma. 1993 Apr;34(4):565-9; discussion 569-70.
The optimal management for traumatic arterial intimal injuries is unresolved. Three therapeutic options were compared in an experimental model employing a standard intimal flap created in 51 canine superficial femoral arteries. Group 1 (14 arteries) underwent resection with end-to-end repair. Group 2 (19 arteries) received acetylsalicylic acid (ASA) and observation only. Group 3 (21 arteries) underwent endovascular excision of the flap with angioscopic guidance. Control intimal flaps (18 arteries) were created and observed without further intervention. Patency in group 1 (primary repair) and group 2 (ASA) was 100%; the patency in both was significantly (p < 0.05) greater than in the controls, which was 67%. Patency in group 3 (endovascular excision) was 79%. Residual luminal defects were observed in only 8% of the arteries repaired primarily, but in 76% of the aspirin-treated arteries. Residual luminal defects following endovascular excision were present in 53% of the arteries remaining patent. Although resection and primary repair (group 1) provided better results than observation alone (control), addition of ASA (group 2) also sustained patency. However, a high incidence of residual intimal defects occurred, the natural history of which is unknown. While endovascular excision (group 3) may become a feasible alternative, current technology provided inferior patency with frequent residual intimal defects. These results suggest that observation alone supplemented with antiplatelet medication (ASA) may be adequate treatment, but longer follow-up is necessary for confirmation.
创伤性动脉内膜损伤的最佳治疗方法尚无定论。在一个实验模型中，对三种治疗方案进行了比较，该模型采用在51条犬股浅动脉中制造的标准内膜瓣。第1组（14条动脉）进行切除并端端修复。第2组（19条动脉）仅接受乙酰水杨酸（ASA）并进行观察。第3组（21条动脉）在血管内镜引导下对内膜瓣进行血管内切除。制作对照内膜瓣（18条动脉）并进行观察，不做进一步干预。第1组（一期修复）和第2组（ASA）的通畅率为100%；两组的通畅率均显著高于对照组（p<0.05），对照组的通畅率为67%。第3组（血管内切除）的通畅率为79%。仅8%一期修复的动脉观察到残留管腔缺损，但阿司匹林治疗的动脉中有76%出现残留管腔缺损。血管内切除后，仍保持通畅的动脉中有53%存在残留管腔缺损。虽然切除并一期修复（第1组）比单纯观察（对照组）效果更好，但加用ASA（第2组）也能维持通畅。然而，残留内膜缺损的发生率很高，其自然病程尚不清楚。虽然血管内切除（第3组）可能成为一种可行的替代方法，但目前的技术通畅率较低，且残留内膜缺损频繁。这些结果表明，单纯观察辅以抗血小板药物（ASA）可能是足够的治疗方法，但需要更长时间的随访来证实。
