Endovascular stent grafts for acute blunt aortic injury.
Endovascular stent grafts for acute blunt aortic injury.
复制标题
血管内覆膜支架用于治疗急性钝性主动脉损伤。
DOI：
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
Randy D. Moore
中科院分区：
文献类型：
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作者：
M. Dunham;D. Zygun;P. Petrasek;J. Kortbeek;R. Karmy;Randy D. Moore
背景
血管内支架移植术（EVSG）已成为治疗主动脉疾病的一种新方法，最近已被应用于治疗急性钝性主动脉损伤（BAI）。本研究的目的是确定两个三级（I级）创伤中心的BAI患者的EVSG结局。
方法
回顾性分析了1999年1月1日至2003年2月1日期间在卡尔加里卫生区（卡尔加里，阿尔伯塔）和Harborview医疗中心（西雅图，华盛顿州）两个中心接受EVSG治疗急性BAI的患者。评估的变量包括年龄、性别、损伤严重度评分、总住院时间（LOS）、重症监护室LOS、手术技术、并发症、技术成功率、死亡率和随访数据。
结果
在此期间确定了28例接受EVSG治疗BAI的患者。12例患者被排除，因为损伤发生在移植前30天以上（n = 7）或根据不同的方案（n = 4），或手术在不同的中心进行（n = 1）。对16例急性BAI患者进行了回顾性分析。平均损伤严重度评分为36.9（SD，17.0），重症监护病房的中位LOS为7.5天（四分位距，1-17天），总LOS为24.5天（四分位距，7-41天）。平均随访10.7个月（范围：3-30个月）。所有患者均获得了技术成功，随访期间未检测到移植物相关并发症，无患者发生术后截瘫。1例术后死亡继发于严重共病损伤。1例术前创伤性颈动脉夹层患者术后发生卒中，1例患者因胸腔积液需要胸腔穿刺术。
结论
在BAI患者中，可以安全地使用EVSG进行BAI修复。死亡率，发病率，特别是截瘫减少。需要进一步的长期研究来支持EVSG技术在BAI中的常规使用。
BACKGROUND
Endovascular stent grafting (EVSG) has emerged as a new treatment for aortic disease and has recently been applied to the treatment of acute blunt aortic injury (BAI). The purpose of this study was to determine the outcome of EVSG for patients with BAI at two tertiary (Level I) trauma centers.
METHODS
A retrospective review of patients treated between January 1, 1999, and February 1, 2003, at two centers, Calgary Health Region (Calgary, Alberta) and Harborview Medical Center (Seattle, WA), with EVSG for acute BAI is reported. Variables assessed included age, sex, Injury Severity Score, total length of stay (LOS), intensive care unit LOS, operative technique, complications, technical success, mortality, and follow-up data.
RESULTS
Twenty-eight patients treated with EVSG for BAI were identified during this period. Twelve patients were excluded because injuries occurred more than 30 days before grafting (n = 7) or under a different protocol (n = 4), or the procedure was performed in a different center (n = 1). Sixteen patients with acute BAI were reviewed. The mean Injury Severity Score was 36.9 (SD, 17.0), with a median intensive care unit LOS of 7.5 days (interquartile range, 1-17 days) and total LOS of 24.5 days (interquartile range, 7-41 days). Mean follow-up was 10.7 months (range, 3-30 months). Technical success was achieved in all patients, no graft-related complications have been detected during follow-up, and no patient developed postoperative paraplegia. One postoperative mortality occurred secondary to severe comorbid injury. A single patient with a preoperative traumatic carotid dissection demonstrated a postoperative stroke, and one patient required thoracentesis for a pleural effusion.
CONCLUSION
Repair of BAI with EVSG can be performed safely in patients with BAI. Mortality, morbidity, and especially paraplegia are reduced. Further long-term studies are required to support the routine use of EVSG technology for BAI.