Objective

This study sought to confirm if thoracic endovascular aortic repair (TEVAR) was an appropriate therapeutic strategy for blunt thoracic aortic injury (BTAI).

Methods

Between 3/2005 and 12/2020, 104 patients with BTAI were brought to our hospital. The severity of each trauma case was evaluated using the Injury Severity Score (ISS); aortic injuries were classified as type I to IV according to Society for Vascular Surgery guidelines. Initial treatment was categorized into four groups: nonoperative management (NOM), open aortic repair (OAR), TEVAR, or emergency room thoracotomy/cardiopulmonary resuscitation (ERT/CPR).

Results

The patients’ mean age and ISS were 56.7 ± 20.9 years and 48.3 ± 20.4, respectively. Type III or IV aortic injury were diagnosed in 82 patients. The breakdown of initial treatments was as follows: NOM for 28 patients, OAR for four, TEVAR for 47, and ERT/CPR for 25. The overall early mortality rate was 32.7%. Logistic regression analysis confirmed ISS > 50 and shock on admission as risk factors for early mortality. The cumulative survival rate of all patients was 61.2% at 5 years after treatment. After initial treatment, eight patients receiving TEVAR required OAR. The cumulative rate of freedom from reintervention using TEVAR at 5 years was higher in approved devices than in custom-made devices (96.0 vs. 56.3%, p = 0.011).

Conclusions

Using TEVAR as an initial treatment for patients with BTAI is a reasonable approach. Patients with severe multiple traumas and shock on admission had poor early outcomes, and those treated with custom-made devices required significant rates of reintervention.

中文翻译：

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胸主动脉腔内修复术一线治疗外伤性钝性胸主动脉损伤的回顾性研究

客观的

本研究旨在确认胸主动脉腔内修复术 (TEVAR) 是否是钝性胸主动脉损伤 (BTAI) 的合适治疗策略。

方法

2005 年 3 月至 2020 年 12 月，104 名 BTAI 患者被送往我院。使用损伤严重程度评分 (ISS) 评估每个创伤病例的严重程度；根据血管外科学会指南，主动脉损伤分为 I ​​至 IV 型。初始治疗分为四组：非手术治疗 (NOM)、开放主动脉修复 (OAR)、TEVAR 或急诊室开胸/心肺复苏 (ERT/CPR)。

结果

患者的平均年龄和 ISS 分别为 56.7 ± 20.9 岁和 48.3 ± 20.4。82 名患者被诊断为 III 型或 IV 型主动脉损伤。初始治疗的细目如下：NOM 28 例，OAR 4 例，TEVAR 47 例，ERT/CPR 25 例。总体早期死亡率为 32.7%。逻辑回归分析证实 ISS > 50 和入院休克是早期死亡的危险因素。所有患者治疗后5年的累计生存率为61.2%。初始治疗后，八名接受 TEVAR 的患者需要 OAR。经批准的器械在 5 年内使用 TEVAR 的累积免于再干预率高于定制器械（96.0 对 56.3%，p  = 0.011）。

结论

使用 TEVAR 作为 BTAI 患者的初始治疗是一种合理的方法。入院时患有严重多发性创伤和休克的患者早期预后较差，使用定制设备治疗的患者需要显着的再干预率。