胸主动脉钝性外伤的腔内修复治疗

目的 探讨腔内修复技术在治疗胸主动脉钝性外伤中的可行性和安全性.方法 回顾分析2010年2月至2013年12月期间7例胸主动脉钝性外伤患者的临床资料.术前CTA及术中造影评估病变,回顾术中技术成功率,死亡及截瘫等主要并发症的发生率.术后CTA随访明确有无内漏、支架移位等情况.结果 所有创伤都累及主动脉峡部,包括Stanford B型夹层1例、降主动脉假性动脉瘤6例.全部患者均接受覆膜支架腔内修复治疗,其中1例先行左-右锁骨下动脉转流术.术中6例部分或全部覆盖左锁骨下动脉开口.所有手术患者均获得技术成功,无死亡及截瘫发生.术后随访时间2～28个月,无左上肢缺血症状及神经系统并发症,支架无内漏及移位.结论 腔内修复治疗胸主动脉夹层安全、有效,可行性高.

Endovascular repair treatment for blunt traumatic thoracic aortic injury

Objective To evaluate the feasibility and safety of endovascular repair of blunt traumatic thoracic aortic injury. Methods The clinical data of 7 patients with blunt traumatic thoracic aortic injury received endovascular treatment between February 2010 and December 2013 were analyzed retrospectively. All patients were evaluated before surgery by CT angiography （CTA） and intraoperative angiography. The technical success rate and the major complications rate such as mortality and paraplegia were analyzed. Follow-up CTA was performed, and complications such as endoleak and stent migration were recorded. Results Thoracic aortic isthmus injury was in- volved in all cases, including 1 case of Stanford type B thoracic aortic dissection and 6 cases of descending aorta pseudoaneurysm. All patients received endovascular repair treatment by stent-graft implantation. The left and right subclavian artery bypass was done first in one patient. 6 cases underwent part or all intentional occlusion of the left subclavian artery during surgery. Technical success was achieved in all patients. No mortality and paraplegia occurred in patients. The follow-up time was 2 to 28 months, and during this period no patients has ischemic syndromes of left upper limb, neurological complications, endoleak and stentt migration. Conclusion Endovascular repair for thoracic arotic dissection is safe, effective treatment and high feasibility.