Endovascular treatment of traumatic dissection of the thoracic aorta – series of 16 cases

Abstract Background Aortic injuries caused by blunt chest traumas have high pre-hospital and emergency mortality. The endovascular approach is one option for treatment of these injuries, but many outcomes related to this approach remain unknown. Objectives The aim of this study is to describe a specialist trauma center’s experience with endovascular treatment of cases like these. Methods This is a descriptive study based on review of the electronic medical records of patients who had suffered from blunt thoracic aorta trauma and were seen at a hospital specializing in trauma cases in the city of Curitiba (Paraná, Brazil). Results Sixteen patients were included in the study. All patients were traffic accident victims and 75% of the accidents were the result of vehicle collisions. Aortic lesions ranged from grade I to IV and the majority had grade II lesions (50%). All patients underwent endovascular treatment with endografts, an average of 71 hours after the trauma. Two patients died, both from causes unrelated to their aortic injuries. During follow-up, only two patients presented complications (endoleak and progression of the dissection). Conclusions The endovascular method is a viable alternative for treatment of blunt trauma thoracic aortic injuries. Randomized and controlled studies are needed to provide evidence to support indication of this method to treat this type of injury.

摘要 背景：钝性胸部创伤所致主动脉损伤的院前及急诊病死率极高。血管内介入疗法是此类损伤的治疗选择之一，但该疗法相关的诸多转归仍未明确。
研究目的：本研究旨在描述一家专科创伤中心针对此类病例开展血管内治疗的临床经验。
方法：本研究为回顾性描述性研究，基于对巴西巴拉那州库里提巴市一家创伤专科医院收治的钝性胸主动脉创伤患者的电子病历进行回顾分析。
结果：本研究共纳入16例患者，全部为交通事故伤者，其中75%的事故由车辆碰撞引发。主动脉损伤分级为I~IV级，多数为II级损伤（占比50%）。所有患者均采用覆膜支架（endografts）行血管内治疗，平均于创伤后71小时接受手术。2例患者死亡，死因为与主动脉损伤无关的其他原因。随访期间仅2例患者出现并发症（内漏及夹层进展）。
结论：血管内治疗是钝性胸主动脉创伤的可行治疗方案。未来仍需开展随机对照研究，为该疗法在此类损伤治疗中的临床应用提供循证依据。