Clinical characteristics and diagnosis and treatment strategies of patients with severe traumatic aortic injury.
10.3760/cma.j.cn112148-20220430-00333
- VernacularTitle:严重创伤性主动脉损伤患者的临床特征及诊疗策略
- Author:
Ying Zhen BU
1
;
Xuan Ze LIU
2
;
Tie Nan ZHOU
2
;
Xu Dong LIU
2
;
Hong Xu JIN
3
;
Xiao Jiang LIU
4
;
Xiao Zeng WANG
2
Author Information
1. Graduate Student Training Base of the General Hospital of Northern Theater Command of Jinzhou Medical University, Shenyang 110016, China Department of Cardiovascology, General Hospital of Northern Theater Command, Shenyang 110016, China.
2. Department of Cardiovascology, General Hospital of Northern Theater Command, Shenyang 110016, China.
3. Department of Emergency, General Hospital of Northern Theater Command, Shenyang 110016, China.
4. Department of Anesthesiology, General Hospital of Northern Theater Command, Shenyang 110016, China.
- Publication Type:Journal Article
- MeSH:
Adult;
Aorta, Thoracic/surgery*;
Aortic Diseases;
Blood Vessel Prosthesis Implantation/adverse effects*;
Endovascular Procedures/methods*;
Female;
Hematoma/surgery*;
Humans;
Male;
Middle Aged;
Pleural Effusion/surgery*;
Retrospective Studies;
Risk Factors;
Treatment Outcome
- From:
Chinese Journal of Cardiology
2022;50(8):767-773
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the clinical characteristics and diagnosis and treatment strategies of patients with severe traumatic aortic injury (TAI). Methods: A total of 25 patients with TAI, who hospitalized in our hospital between August 2005 to March 2021 and underwent thoracic aortic endovascular repair (TEVAR), were included in this retrospective study. According to the time from admission to TEVAR, the patients were divided into emergency TEVAR group (14 cases, TEVAR within 24 h of admission) and elective TEVAR group (11 cases, patients underwent surgery or fracture reduction and fixation first for serious injuries and then underwent TEVAR more than 24 h after admission). The general clinical data of patients, injury severity score (ISS), time from admission to intervention, total hospital stay, the proportion of closed chest drainage and the proportion of abdominal organ repair were obtained and compared. Clinical follow-up and 1-year postoperative aortic computed tomography angiography (CTA) were performed on the patients. Death, the occurrence of aortic adverse events and injury recovery were followed up and recorded. Results: The mean age of these 25 TAI patients was (41.4±14.4) years, 20 patients were males (80.0%). 21 patients (84.0%) had persistent chest and back pain, 17 (68.0%) had pleural effusion and 5 (20.0%) had mediastinal hematoma. The injury severity score (ISS) was significantly higher in the elective TEVAR group than in the emergency TEVAR group (24.9±14.4 vs. 35.5±9.3, P=0.044). The time from admission to intervention ((1.0±0.0) d vs. (3.4±0.9) d, P<0.001], the time from admission to TEVAR ((1.0±0.0) d vs. (11.5±13.8) d, P=0.030) and total hospital stay ((6.1±2.3) d vs. (26.8±7.7) d, P<0.001) were significantly longer in elective TEVAR group than in emergency TEVAR group. The proportion of thoracic closed drainage was significantly lower in the elective TEVAR group than in the emergency TEVAR group (9 (64.3%) vs. 2 (18.2%), P=0.042). The proportion of abdominal organ repair was significantly higher than in the emergency TEVAR group (0 vs. 4 (36.4%), P=0.026). All of 25 patients were discharged alive and followed up for (84.0±30.5) months. All patients survived and completed 1-year postoperation CTA. There were no aortic adverse events occurred, and no complications after surgery, and the fractures and organ injuries healed well. Conclusions: The clinical characteristics of severe TAI are acute multi-injuries combined with persistent chest and/or back pain, pleural effusion, and mediastinal hematoma. Timely diagnosis and treatment are important factors for the outcome. The treatment strategy for multi-injuries should give priority to dealing with life-threatening injuries. TEVAR is the primary treatment strategy for severe TAI and is related to satisfactory outcomes.
