Dissection of the abdominal aorta in blunt trauma:: Endovascular or conventional surgical management?
Dissection of the abdominal aorta in blunt trauma:: Endovascular or conventional surgical management?
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DOI：
10.1016/s0741-5214(03)00613-x
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发表时间：
2003-11-01
影响因子：
4.3
通讯作者：
Alric, P
中科院分区：
文献类型：
--
作者：
Berthet, JP;Marty-Ané, CH;Alric, P
背景资料：钝性创伤造成腹主动脉剥离是一种罕见的损伤，常并发真假腔内血栓形成，有时主动脉破裂。保守的医疗管理的死亡率约为75%，而它的范围从18%到37%与手术treatment.Methods：在我们的机构，7的87例患者承认，因为钝性主动脉创伤，1995年1月至2002年1月，有腹主动脉disorder.Results：4例患者采用血管内技术经皮支架置入术。血管内治疗的适应症为1例下肢缺血，2例夹层扩大; 1例患者无症状。主动脉夹层合并缺血性截瘫2例，均行常规手术修补。1例患者因轻微内膜破裂接受药物治疗。没有死亡与主动脉夹层或其治疗相关。血管造影和计算机断层扫描（CT）研究显示，血管内组的假腔血栓形成和夹层完全闭塞。两例截瘫患者的神经系统状况完全或部分改善。结论：在没有缺血性截瘫或其他需要急诊手术的损伤的情况下，血管内治疗是治疗创伤性肾下主动脉夹层的安全有效的方法。
Background: Dissection of the abdominal aorta caused by blunt trauma is a rare injury, often complicated by thrombosis within the true and false lumens and sometimes aortic rupture. The mortality rate with conservative medical management is approximately 75%, whereas it ranges from 18% to 37% with surgical treatment.Methods: At our institution, 7 of the 87 patients admitted because of blunt aortic trauma, between January 1995 and January 2002, had abdominal aortic dissection.Results: Four patients were treated using endovascular techniques by percutaneous stent placement. The indications for endovascular management were lower limb ischemia in one case and extension of the dissection in two; one patient was asymptomatic. Aortic dissection was complicated by ischemic paraplegia in two patients, and both were treated by conventional operative repair. One patient was managed medically because of a minimal intimal disruption. No deaths were related to the aortic dissection or its treatment. Angiographic and computed tomographic (CT) studies showed thrombosis of the false lumen and complete obliteration of the dissection in the endovascular group. The neurologic condition of the two paraplegic patients either cleared completely or partially improved.Conclusion: In the absence of ischemic paraplegia or other injuries that require emergency surgery, endovascular treatment is a safe and efficient method for treating traumatic infrarenal aortic dissection.